Premier Dental Clinic, LLC
Dentist, General Practice in Aurora, IL. Organization (NPI-2).
NPI number1386815744
StatusActive
Last updated in NPPESMar 20, 2020
Details
- NPI
- 1386815744
- Entity type
- Organization (NPI-2)
- Legal business name
- Premier Dental Clinic, LLC
- Organization subpart
- No
- Enumeration date
- Mar 13, 2008
- Certification date
- Mar 20, 2020
- Last updated
- Mar 20, 2020
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 1223G0001X | Dentist, General Practice | 019024846 | IL | Yes |
Practice location
1264b N Lake StAurora, IL 60506-2453
Phone 630-801-9028
Mailing address
1264b N Lake StAurora, IL 60506-2453
Authorized official
Phil Kural
Director Doctor Credentialing
3122744526
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