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Organization

ARTISAN DENTAL GROUP - RICHARD MADDALOZZO DDS MS LLC

Active
Parent organization
ARTISAN DENTAL GROUP OF ILLINOIS LLC
Organization subpart
Yes

Provider details

NPI number
Legal business name
ARTISAN DENTAL GROUP OF ILLINOIS LLC
Authorized official
DR. RICHARD MADDALOZZO D.D.S., M.S. (MEMBER)
(847) 934-4280
Entity
Organization

Contact information

Practice address
649 N 1ST BANK DR, PALATINE, IL 60067-8111
(847) 934-4280
(847) 934-4294
Mailing address
649 N 1ST BANK DR, PALATINE, IL 60067-8111
(847) 934-4280
(847) 934-4294

Taxonomy

Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
019021223
IL
1223G0001X
General Practice Dentistry
019021223
IL
1223P0300X
Periodontics
021001510
IL

Other

Enumeration date
02/02/2017
Last updated
02/02/2017
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