Bolingbrook Dental Associates LLC
Clinic/Center, Dental in Bolingbrook, IL. Organization (NPI-2).
NPI number1003370248
StatusActive
Last updated in NPPESJan 22, 2019
Details
- NPI
- 1003370248
- Entity type
- Organization (NPI-2)
- Legal business name
- Bolingbrook Dental Associates LLC
- Organization subpart
- No
- Enumeration date
- Jan 22, 2019
- Last updated
- Jan 22, 2019
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 261QD0000X | Clinic/Center, Dental | – | – | Yes |
Practice location
391 Quadrangle DrBolingbrook, IL 60440-3442
Phone 630-759-4400
Mailing address
391 Quadrangle DrBolingbrook, IL 60440-3442
Phone 630-759-4400
Authorized official
Oscar G Gonzalez
Director Of Operations
2194658627
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