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Organization
PREMIER DENTAL GROUP PERSONAL CORPORATION
Active
Organization
PREMIER DENTAL GROUP PERSONAL CORPORATION
Active
Other names
West Willow Family Dental
Organization subpart
No
Provider details
NPI number
Authorized official
ANTHONY AMODIO BRUCCI DMD (DENTIST/OWNER)
(708) 308-9929
Entity
Organization
Contact information
Practice address
300 S WEST ST, WHEATON, IL 60187-5021
(630) 665-0650
(708) 484-0843
Mailing address
183 N ADDISON AVE APT 216, ELMHURST, IL 60126-3195
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
—
—
1223G0001X
General Practice Dentistry
—
—
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
04/21/2023
Last updated
04/25/2023
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