Organization
KATY DENTAL, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARTHA CATALINA VILLASENOR D.D.S. (OWNER)
(708) 601-5081
Entity
Organization
Contact information
Practice address
3510 HOBSON RD, SUITE 302, WOODRIDGE, IL 60517-1439
(630) 971-3626
(630) 971-3752
Mailing address
3510 HOBSON RD, SUITE 302, WOODRIDGE, IL 60517-1439
(630) 971-3626
(630) 971-3752
Taxonomy
Speciality
Code
Description
License number
State
302R00000X
Health Maintenance Organization
Primary
019024012
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
019024012
—
IL
Enumeration date
08/13/2013
Last updated
08/13/2013
Update your record
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