Organization
ATDENTAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KHA M NGUYEN DMD (MANAGING MEMBER)
(708) 957-2030
Entity
Organization
Contact information
Practice address
19730 GOVERNORS HWY, SUITE 1, FLOSSMOOR, IL 60422
(708) 957-2030
Mailing address
162 MELROSE AVE, ELMHURST, IL 60126
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
019028743
IL
Other
Enumeration date
08/06/2014
Last updated
08/06/2014
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