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Organization
RIVER GROVE DENTAL ASSOCIATES LLC
Active
Organization
RIVER GROVE DENTAL ASSOCIATES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. FRANK SIRACUSA DDS (MEMBER/ OWNER)
(708) 453-1110
Entity
Organization
Contact information
Practice address
8225 GRAND AVE, RIVER GROVE, IL 60171-1517
(708) 453-1110
Mailing address
8225 GRAND AVE, RIVER GROVE, IL 60171-1517
(708) 453-1110
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
019021920
IL
Other
Enumeration date
07/11/2010
Last updated
07/11/2010
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