Organization
LAGRANGE PARK DENTISTRY PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RYAN PETERSON DMD (PRESIDENT/OWNER)
(708) 846-3436
Entity
Organization
Contact information
Practice address
360 SHERWOOD RD, LA GRANGE PARK, IL 60526-1967
(708) 354-7363
Mailing address
5924 TYLER DR, WOODRIDGE, IL 60517-1007
(708) 846-3436
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
08/15/2025
Last updated
08/15/2025
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