1053431981 NPI number — DENTAL SLEEP CENTER RICHARD A CRAIG DDS LTD

Table of content: (NPI 1053431981)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053431981 NPI number — DENTAL SLEEP CENTER RICHARD A CRAIG DDS LTD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DENTAL SLEEP CENTER RICHARD A CRAIG DDS LTD
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
MIDWEST DENTAL SLEEP CENTER
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1053431981
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/01/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
14831 W 159TH ST STE 1
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOCKPORT
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60491-9008
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
312-676-9892
Provider Business Mailing Address Fax Number:
815-744-7059

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
14831 W 159TH ST STE 1
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOCKPORT
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60491-9008
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
312-676-9892
Provider Business Practice Location Address Fax Number:
815-744-7059
Provider Enumeration Date:
04/02/2007

Additional Information

Authorized Official

Authorized Official Last Name:
CRAIG
Authorized Official First Name:
RICHARD
Authorized Official Middle Name:
ALLEN
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
312-676-9892

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RS0012X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QD0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1306177241 . This is a "OAK BROOK SVC LOCATION" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1205145554 . This is a "SHOREWOOD SVC LOCATION" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1295165439 . This is a "BARRINGTON SVC LOCATION" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1760882005 . This is a "SKOKIE SVC LOCATION" identifier . This identifiers is of the category "OTHER".
  • Identifier: 6472260002 . This is a "MEDICARE NSC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1508198474 . This is a "CHICAGO SVC LOCATION" identifier . This identifiers is of the category "OTHER".
  • Identifier: 6472260001 . This is a "MEDICARE NSC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 6472260005 . This is a "MEDICARE NSC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 6472260003 . This is a "MEDICARE NSC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 6472260004 . This is a "MEDICARE NSC" identifier . This identifiers is of the category "OTHER".




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