Provider Demographics
NPI:1427886183
Name:VILLAGE FAMILY DENTAL, LLC
Entity type:Organization
Organization Name:VILLAGE FAMILY DENTAL, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SONES
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:618-797-1515
Mailing Address - Street 1:3949 IL-111
Mailing Address - Street 2:
Mailing Address - City:GRANITE CITY
Mailing Address - State:IL
Mailing Address - Zip Code:60240
Mailing Address - Country:US
Mailing Address - Phone:618-797-1515
Mailing Address - Fax:
Practice Address - Street 1:3949 IL-111
Practice Address - Street 2:
Practice Address - City:GRANITE CITY
Practice Address - State:IL
Practice Address - Zip Code:60240
Practice Address - Country:US
Practice Address - Phone:618-797-1515
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-24
Last Update Date:2024-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1639499791OtherNPI
IL1134961758OtherNPI
IL1588344824OtherNPI