Provider Demographics
NPI:1962913376
Name:COSMOS FAMILY DENTAL PC
Entity type:Organization
Organization Name:COSMOS FAMILY DENTAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TANIA
Authorized Official - Middle Name:
Authorized Official - Last Name:LODHI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:630-229-6503
Mailing Address - Street 1:1187 N FARNSWORTH AVE UNIT 101
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60505-2270
Mailing Address - Country:US
Mailing Address - Phone:630-229-6503
Mailing Address - Fax:630-229-6396
Practice Address - Street 1:1187 N FARNSWORTH AVE UNIT 101
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60505-2270
Practice Address - Country:US
Practice Address - Phone:630-229-6503
Practice Address - Fax:630-229-6396
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-12
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019-028960261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========OtherTIN