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Organization
STRATFORD DENTAL PC
Active
Organization
STRATFORD DENTAL PC
Active
Other names
Bloomingdale Dental Sleep Therapy
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRIAN T EVANS (OWNER)
(630) 980-3880
Entity
Organization
Contact information
Practice address
290 SPRINGFIELD DR, SUITE #130, BLOOMINGDALE, IL 60108-2214
(630) 980-3880
(630) 980-4828
Mailing address
290 SPRINGFIELD DR, SUITE #130, BLOOMINGDALE, IL 60108-2214
(630) 980-3880
(630) 980-4828
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
019020133
IL
332BC3200X
Customized Equipment (DME)
—
—
Other
Enumeration date
09/27/2012
Last updated
01/14/2016
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