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Organization
EDP OF ILLINOIS P.C
Active
Organization
EDP OF ILLINOIS P.C
Active
Other names
Affordable Dental of Illnois
Organization subpart
No
Provider details
NPI number
Authorized official
MELISSA GARIBAY (CREDENTIALING MANAGER)
(312) 736-8963
Entity
Organization
Contact information
Practice address
195 S MAIN ST, DUPO, IL 62239-1347
(312) 800-1270
Mailing address
141 W JACKSON BLVD STE 210, CHICAGO, IL 60604-3048
(312) 800-1270
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
021.001656
IL
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
02/18/2015
Last updated
09/29/2021
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