Organization
LAGRANGE DENTAL MANAGEMENT
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JONATHAN VILLANUEVA (PRACTICE MANAGER)
(630) 324-6749
Entity
Organization
Contact information
Practice address
342 SHERWOOD RD, LA GRANGE PARK, IL 60526-1967
(708) 482-4610
(708) 482-0246
Mailing address
342 SHERWOOD RD, LA GRANGE PARK, IL 60526-1967
(708) 482-4610
(708) 482-0246
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
019022779
IL
Other
Enumeration date
04/23/2009
Last updated
04/23/2009
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