Organization
LAGRANGE PERIODONTICS, LTD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MICHELLE P JENNINGS DDS (PRESIDENT/PERIODONTIST)
(708) 354-4545
Entity
Organization
Contact information
Practice address
6520 JOLIET RD, COUNTRYSIDE, IL 60525
(708) 354-4545
(708) 354-0336
Mailing address
6520 JOLIET RD, COUNTRYSIDE, IL 60525-4649
(708) 354-4545
(708) 354-0336
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
21001423
IL
1223P0300X
Periodontics
Primary
21001561
IL
Other
Enumeration date
01/02/2007
Last updated
10/30/2019
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