Provider Demographics
NPI:1497019301
Name:WESTMONT DENTAL SALON, P.C.
Entity type:Organization
Organization Name:WESTMONT DENTAL SALON, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WESLEY
Authorized Official - Middle Name:ERIC
Authorized Official - Last Name:CAMPIN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:630-515-1414
Mailing Address - Street 1:519 N CASS AVE
Mailing Address - Street 2:SUITE 1E
Mailing Address - City:WESTMONT
Mailing Address - State:IL
Mailing Address - Zip Code:60559-1514
Mailing Address - Country:US
Mailing Address - Phone:630-515-1414
Mailing Address - Fax:630-515-9729
Practice Address - Street 1:519 N CASS AVE
Practice Address - Street 2:SUITE 1E
Practice Address - City:WESTMONT
Practice Address - State:IL
Practice Address - Zip Code:60559-1514
Practice Address - Country:US
Practice Address - Phone:630-515-1414
Practice Address - Fax:630-515-9729
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-26
Last Update Date:2012-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019-0261411223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty