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Organization
FAMILY DENTAL PRACTICE
Active
Organization
FAMILY DENTAL PRACTICE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SUSAN EDUKUTHARAYIL (GENERAL DENTIST)
(847) 581-1418
Entity
Organization
Contact information
Practice address
9709 MILWAUKEE AVE, GLENVIEW, IL 60025-4567
(847) 581-1418
Mailing address
9709 MILWAUKEE AVE, GLENVIEW, IL 60025-4567
Taxonomy
Speciality
Code
Description
License number
State
305R00000X
Preferred Provider Organization
Primary
019024490
IL
Other
Enumeration date
10/21/2016
Last updated
10/21/2016
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