Organization
GURNEE ORTHODONTICS LLC
Active
Organization
GURNEE ORTHODONTICS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TERRY SELLKE DDS MS (PRESIDENT)
(847) 249-1000
Entity
Organization
Contact information
Practice address
101 S GREENLEAF ST, UNIT E, GURNEE, IL 60031-3369
(847) 249-1000
(847) 249-1001
Mailing address
30 N SLUSSER ST, GRAYSLAKE, IL 60030-3662
(847) 249-1000
(847) 249-1001
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
021000786
IL
Other
Enumeration date
03/18/2013
Last updated
03/18/2013
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