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Organization
SWAN DENTAL P.C.
Active
Organization
SWAN DENTAL P.C.
Active
Other names
Avon Dental P.C.
Organization subpart
No
Provider details
NPI number
Authorized official
SIDDHARTH BANSAL DMD (SECRETARY)
(352) 872-8066
Entity
Organization
Contact information
Practice address
23 W ROLLINS RD, ROUND LAKE BEACH, IL 60073-1350
(847) 740-4600
Mailing address
1460 S PEORIA ST, CHICAGO, IL 60608-2208
(352) 872-8066
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
019028736
IL
Other
Enumeration date
01/19/2014
Last updated
01/19/2014
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