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Organization

APOLLO DENTAL CLINIC, LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. SUMRANA S AHMED DDS (MEMBER)
(630) 267-4205
Entity
Organization

Contact information

Practice address
6121 WASHINGTON ST, SUITE 203, GURNEE, IL 60031-5305
(630) 267-4205
(630) 477-0447
Mailing address
6121 WASHINGTON ST, SUITE 203, GURNEE, IL 60031-5305
(630) 267-4205
(630) 477-0447

Taxonomy

Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
019026293
IL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1005798
IL
Enumeration date
03/10/2010
Last updated
03/10/2010
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