Organization
EDP OF ILLINOIS P.C
Active
Other names
Affordable Dental of Illnois
Organization subpart
No
Provider details
NPI number
Authorized official
MELISSA GARIBAY (CREDENTIALING MANAGER)
(312) 736-8963
Entity
Organization
Contact information
Practice address
195 S MAIN ST, DUPO, IL 62239-1347
(312) 800-1270
Mailing address
141 W JACKSON BLVD STE 210, CHICAGO, IL 60604-3048
(312) 800-1270
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
021.001656
IL
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
02/18/2015
Last updated
09/29/2021
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