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Organization
CHICAGOLAND IMPLANT SPECIALIST LTD
Active
Organization
CHICAGOLAND IMPLANT SPECIALIST LTD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. PAUL S PETRUNGARO DDS (OWNER)
(312) 415-7481
Entity
Organization
Contact information
Practice address
237 S MAIN ST, LOMBARD, IL 60148-2647
(312) 533-8489
Mailing address
6420 N LEHIGH AVE, CHICAGO, IL 60646-2704
(312) 624-9300
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
Primary
021001401
IL
Other
Enumeration date
06/13/2016
Last updated
01/24/2017
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