Provider Demographics
NPI:1427190818
Name:SANDPIPER DENTAL P.C.
Entity type:Organization
Organization Name:SANDPIPER DENTAL P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:
Authorized Official - Last Name:LAO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-588-1700
Mailing Address - Street 1:1N141 COUNTY FARM RD
Mailing Address - Street 2:SUITE 150
Mailing Address - City:WINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60190-2032
Mailing Address - Country:US
Mailing Address - Phone:630-588-1700
Mailing Address - Fax:630-588-1706
Practice Address - Street 1:1N141 COUNTY FARM RD
Practice Address - Street 2:SUITE 150
Practice Address - City:WINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60190-2032
Practice Address - Country:US
Practice Address - Phone:630-588-1700
Practice Address - Fax:630-588-1706
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-13
Last Update Date:2008-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019-021716122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty