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Organization
NELSON RIDGE FAMILY DENTAL
Active
Organization
NELSON RIDGE FAMILY DENTAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. PAUL E ETCHISON DDS (OWNER)
(815) 524-6000
Entity
Organization
Contact information
Practice address
820 LARAWAY RD, NEW LENOX, IL 60451-2694
(815) 524-6000
Mailing address
820 LARAWAY RD, NEW LENOX, IL 60451-2694
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
019.027903
IL
Other
Enumeration date
03/08/2012
Last updated
03/08/2012
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