Organization
ASSOCIATED DENTAL SPECIALISTS OF LONG GROVE LTD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARK L CANNON DDS (PRESIDENT)
(847) 634-6166
Entity
Organization
Contact information
Practice address
RFD 4160, GROVE MEDICAL CENTER SUITE 308, LONG GROVE, IL 60047-9586
(847) 634-6166
(846) 634-6302
Mailing address
RFD 4160, GROVE MEDICAL CENTER SUITE 308, LONG GROVE, IL 60047-9586
(847) 634-6166
(846) 634-6302
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
060.003411019.021533
IL
Other
Enumeration date
04/16/2008
Last updated
04/16/2008
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