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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
GEORGE A MANDELARIS DDS (OWNER PERIODONTIST)
(630) 627-3930
Entity
Organization
Contact information
Practice address
1S224 SUMMIT AVE, SUITE 205, OAKBROOK TERRACE, IL 60181-3983
(630) 627-3930
(630) 627-2148
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
019024971
IL
1223P0300X
Periodontics
019030200
IL
261QD0000X
Dental Clinic/Center
Primary
060-003629
IL
Other
Enumeration date
02/06/2007
Last updated
12/16/2016
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