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Organization
PERIODONTAL MEDICINE AND SURGICAL SPECIALISTS, LLC
Active
Organization
PERIODONTAL MEDICINE AND SURGICAL SPECIALISTS, LLC
Active
Other names
Periodontal Medicine and Surgical Specialists, LTD
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GEORGE A MANDELARIS DDS (OWNER PERIODONTIST)
(630) 627-3930
Entity
Organization
Contact information
Practice address
1875 DEMPSTER ST, SUITE 250, PARK RIDGE, IL 60068-1186
(847) 698-1180
(847) 698-1185
Mailing address
1S224 SUMMIT AVE, SUITE 205, OAKBROOK TERRACE, IL 60181-3983
(630) 627-3930
(630) 627-2148
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
019014972
IL
1223P0300X
Periodontics
Primary
019024971
IL
1223P0300X
Periodontics
019030200
IL
124Q00000X
Dental Hygienist
020005282
IL
Other
Enumeration date
02/06/2007
Last updated
12/29/2016
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