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Organization
PERIODONTAL MEDICINE AND SURGICAL SPECIALISTS, LLC
Active
Organization
PERIODONTAL MEDICINE AND SURGICAL SPECIALISTS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MOLLY WALSH (PRACTICE OPERATIONS DIRECTOR)
(630) 627-3930
Entity
Organization
Contact information
Practice address
2300 LEHIGH AVE STE 210, GLENVIEW, IL 60026-1691
(630) 627-3930
Mailing address
1S224 SUMMIT AVE STE 205, OAKBROOK TERRACE, IL 60181-3943
(630) 627-3930
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
Primary
—
—
261QD0000X
Dental Clinic/Center
—
—
Other
Enumeration date
03/04/2022
Last updated
03/04/2022
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