Organization
DENTAL PROFESSIONALS OF ILLINOIS, P.C
Active
Parent organization
DENTAL PROFESSIONALS OF ILLINOIS, P.C.
Other names
Woodridge Dental
Organization subpart
Yes
Provider details
NPI number
Legal business name
DENTAL PROFESSIONALS OF ILLINOIS, P.C.
Authorized official
TABATHA LEMKE (CREDENTIALING COORDINATOR)
(217) 540-6078
Entity
Organization
Contact information
Practice address
2839 83RD ST, DARIEN, IL 60561-5612
(360) 871-5100
Mailing address
2839 83RD ST, DARIEN, IL 60561-5612
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
05/06/2021
Last updated
05/06/2021
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