Provider Demographics
NPI:1528501962
Name:H & H FAMILY DENTAL, PC
Entity type:Organization
Organization Name:H & H FAMILY DENTAL, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:
Authorized Official - Last Name:LIPIC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:309-662-0523
Mailing Address - Street 1:10 HEARTLAND DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:61704-7741
Mailing Address - Country:US
Mailing Address - Phone:309-662-0523
Mailing Address - Fax:309-662-7693
Practice Address - Street 1:607 E CLINTON AVE
Practice Address - Street 2:
Practice Address - City:FARMER CITY
Practice Address - State:IL
Practice Address - Zip Code:61842-9233
Practice Address - Country:US
Practice Address - Phone:309-928-2727
Practice Address - Fax:309-928-9114
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:H & H FAMILY DENTAL FARMER CITY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-12-01
Last Update Date:2018-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019-0255051223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL33486OtherBC/BS ID#