Individual
DR. ELLEN E TKACH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
1846 BELVIDERE RD, GRAYSLAKE, IL 60030-2289
(847) 223-0100
(847) 223-6528
Mailing address
1846 BELVIDERE RD, GRAYSLAKE, IL 60030-2289
(847) 223-0100
(847) 223-6528
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1003995
—
IL
Enumeration date
04/09/2008
Last updated
04/10/2008
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