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Organization

WINTHROP HARBOR DENTAL CENTER

Active
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Organization

WINTHROP HARBOR DENTAL CENTER

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MRS. MICHELLE L OPELT (BUSINESS MANAGER)
(847) 872-5626
Entity
Organization

Contact information

Practice address
644 SHERIDAN RD, SUITE 105, WINTHROP HARBOR, IL 60096-1350
(847) 872-5626
(847) 746-2900
Mailing address
644 SHERIDAN RD, SUITE 105, WINTHROP HARBOR, IL 60096-1350
(847) 872-5626
(847) 746-2900

Taxonomy

Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
019015026
IL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
BCBS OF IL
80006341
IL
01
TRI-CARE
603323
IL
01
UNITED CONCORDIA
603323
IL
Enumeration date
08/02/2006
Last updated
11/28/2011
About Stedi
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