| Hickory Dentistry Llc | |
|
9556 S Roberts Rd Hickory Hills IL 60457-2239 | |
| (708) 608-0095 | |
| Not Available |
| Full Name | Hickory Dentistry Llc |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 9556 S Roberts Rd, Hickory Hills, Illinois |
| Authorized Official Name and Position | Prasanth Dommaraju (OWNER) |
| Authorized Official Contact | 6302477216 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Hickory Dentistry Llc 3924 S Archer Ave Unit D Chicago IL 60632-1116 Ph: (773) 819-7101 | Hickory Dentistry Llc 9556 S Roberts Rd Hickory Hills IL 60457-2239 Ph: (708) 608-0095 |
| NPI Number | 1275131948 |
|---|---|
| Provider Enumeration Date | 10/14/2020 |
| Last Update Date | 07/25/2025 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1275131948 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | (* (Not Available)) | Secondary |
| 1223G0001X | Dentist - General Practice | (* (Not Available)) | Primary |
Dentalaveinc Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 7608 W 95th St, Hickory Hills, IL 60457 Phone: 708-737-5459 |