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Organization
LAKE FOREST PEDIATIC DENTISTRY, PC
Active
Organization
LAKE FOREST PEDIATIC DENTISTRY, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOSEPH GORDON D.D.S. (PEDIATRIC DENTIST, PRESIDENT)
(847) 482-1900
Entity
Organization
Contact information
Practice address
500 N WESTERN AVE, SUITE 215, LAKE FOREST, IL 60045-1954
(847) 482-1900
Mailing address
500 N WESTERN AVE, SUITE 215, LAKE FOREST, IL 60045-1954
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
019024258
IL
Other
Enumeration date
07/25/2014
Last updated
07/25/2014
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