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Organization

INNOVATIVE DENTAL MANAGEMENT

Active
Other names
Great Lakes Dental
Organization subpart
No

Provider details

NPI number
Authorized official
MR. RAJA GOEL (BUSINESS OWNER)
(847) 265-6444
Entity
Organization

Contact information

Practice address
2246 E GRAND AVE, LINDENHURST, IL 60046-7522
(847) 265-6444
(847) 264-6464
Mailing address
2246 E GRAND AVE, LINDENHURST, IL 60046-7522
(847) 265-6444
(847) 264-6464

Taxonomy

Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
019025462
IL
1223G0001X
General Practice Dentistry
Primary
019025474
IL

Other

Enumeration date
12/16/2009
Last updated
12/16/2009
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