Organization
LAVERGNE DENTAL CARE PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SHERIN B JACOB DDS (PRESIDENT)
(708) 652-1080
Entity
Organization
Contact information
Practice address
4939 W 14TH ST, CICERO, IL 60804-1419
(708) 652-1080
(708) 652-3080
Mailing address
4939 W 14TH ST, CICERO, IL 60804-1419
(708) 652-1080
(708) 652-3080
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
179906
—
IL
Enumeration date
01/09/2008
Last updated
01/09/2008
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