Organization
SUBURBAN FAMILY DENTAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARY MILLER (OFFICE MANAGER)
(847) 640-0778
Entity
Organization
Contact information
Practice address
645 W GOLF RD, DES PLAINES, IL 60016-2462
(847) 640-0778
(847) 640-2599
Mailing address
645 WEST GOLF ROAD, DES PLAINES, IL 60016
(847) 640-0778
(847) 640-2599
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
019016362
IL
1223G0001X
General Practice Dentistry
019022514
IL
1223P0300X
Periodontics
019022485
IL
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
019016834
IL
Other
Enumeration date
04/08/2009
Last updated
04/08/2009
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