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Organization

DENTAL ON 45 INC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MRS. MARLEN FAJARDO (OFFICE MANAGER)
(224) 541-4066
Entity
Organization

Contact information

Practice address
34484 N US HIGHWAY 45, SUITE C, THIRD LAKE, IL 60030-4038
(224) 541-4066
(847) 752-8425
Mailing address
34484 N US HIGHWAY 45, SUITE C, THIRD LAKE, IL 60030-4038
(224) 541-4066
(847) 752-8425

Taxonomy

Speciality
Code
Description
License number
State
122300000X
Dentist
Primary

Other

Enumeration date
08/07/2014
Last updated
08/07/2014
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