Provider Demographics
NPI:1720432354
Name:WOODGROVE FAMILY DENTAL PC
Entity type:Organization
Organization Name:WOODGROVE FAMILY DENTAL PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NEELAM
Authorized Official - Middle Name:
Authorized Official - Last Name:ALOOR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:630-869-0869
Mailing Address - Street 1:1001 W 75TH STREET
Mailing Address - Street 2:SUITE 165
Mailing Address - City:WOODRIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60517-2655
Mailing Address - Country:US
Mailing Address - Phone:630-869-0869
Mailing Address - Fax:630-869-0860
Practice Address - Street 1:1001 W 75TH STREET
Practice Address - Street 2:SUITE 165
Practice Address - City:WOODRIDGE
Practice Address - State:IL
Practice Address - Zip Code:60517-2655
Practice Address - Country:US
Practice Address - Phone:630-869-0869
Practice Address - Fax:630-869-0860
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-20
Last Update Date:2016-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.028475305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service