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Organization
BOSACK DENTAL LLC
Active
Organization
BOSACK DENTAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
REBECCA BOSACK (DENTIST/SOLE MEMBER)
(708) 403-0005
Entity
Organization
Contact information
Practice address
16045 108TH AVE STE A, ORLAND PARK, IL 60467-5345
(708) 403-0005
Mailing address
16045 108TH AVE STE A, ORLAND PARK, IL 60467-5345
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
04/17/2018
Last updated
12/21/2020
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