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Organization
PRO DENTAL IL - CHAD WISE PC
Active
Organization
PRO DENTAL IL - CHAD WISE PC
Active
Other names
Destiny Dental of Niles
Organization subpart
No
Provider details
NPI number
Authorized official
SIMONE WILSON-ADELEKE MPA-PPA (DIRECTOR OF CREDENTIALING)
(732) 731-8398
Entity
Organization
Contact information
Practice address
5622 W TOUHY AVE, NILES, IL 60714-4001
(847) 983-4202
(847) 983-8403
Mailing address
10 WOODBRIDGE CENTER DR STE 520, WOODBRIDGE, NJ 07095-1152
(732) 731-8398
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
09/19/2024
Last updated
09/19/2024
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