Organization
ELLEN E. TKACH, DDS, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ELLEN E TKACH DDS (DENTIST)
(847) 431-4416
Entity
Organization
Contact information
Practice address
1464 TOWNLINE RD, MUNDELEIN, IL 60060-4433
(847) 566-7850
(847) 566-7851
Mailing address
1464 TOWNLINE RD, MUNDELEIN, IL 60060-4433
(847) 566-7850
(847) 566-7851
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
019-021157
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1194998252
—
IL
Enumeration date
09/16/2014
Last updated
09/16/2014
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