# ASSOCIATED DENTAL SPECIALISTS OF LONG GROVE LTD

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1033383567
- **Authorized official:** DR. MARK L CANNON DDS (PRESIDENT)
- **Authorized official phone:** (847) 634-6166

## Contact information

- **Practice address:** RFD 4160, GROVE MEDICAL CENTER SUITE 308, LONG GROVE, IL 60047-9586
- **Practice address phone:** (847) 634-6166
- **Practice address fax:** (846) 634-6302
- **Mailing address:** RFD 4160, GROVE MEDICAL CENTER SUITE 308, LONG GROVE, IL 60047-9586
- **Mailing address phone:** (847) 634-6166
- **Mailing address fax:** (846) 634-6302

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223P0221X | Pediatric Dentistry | 060.003411019.021533 | IL | Yes |

## Other

- **Enumeration date:** 04/16/2008
- **Last updated:** 04/16/2008