Organization
KEDZIE DENTISTRY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PRASANTH DOMMARAJU DMD (DIRECTOR)
(630) 247-7216
Entity
Organization
Contact information
Practice address
5430 S KEDZIE AVE, CHICAGO, IL 60632-2620
(773) 295-2523
Mailing address
5430 S KEDZIE AVE, CHICAGO, IL 60632-2620
(773) 295-2523
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
—
—
1223G0001X
General Practice Dentistry
Primary
—
—
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
—
—
Other
Enumeration date
11/28/2025
Last updated
11/28/2025
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