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Organization
VILLAGE DENTAL, PC
Active
Organization
VILLAGE DENTAL, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CATHY S WATERLOO DDS (OWNER)
(847) 251-8990
Entity
Organization
Contact information
Practice address
523 PARK DR, KENILWORTH, IL 60043-1082
(847) 251-8990
(847) 853-0781
Mailing address
523 PARK DR, KENILWORTH, IL 60043-1082
(847) 251-8990
(847) 853-0781
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
019022877
IL
Other
Enumeration date
09/29/2015
Last updated
09/29/2015
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