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Organization
PROFESSIONAL DENTAL ALLIANCE OF GROVE DENTAL LLC
Active
Organization
PROFESSIONAL DENTAL ALLIANCE OF GROVE DENTAL LLC
Active
Other names
Grove Dental
Organization subpart
No
Provider details
NPI number
Authorized official
AMANDA KURTZ (CREDENTIALING SPECIALIST)
(724) 698-2058
Entity
Organization
Contact information
Practice address
160 E BOUGHTON RD, BOLINGBROOK, IL 60440-2014
(630) 759-8940
Mailing address
PO BOX 715279, CINCINNATI, OH 45271-5279
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
03/20/2020
Last updated
04/29/2021
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