Organization
PRAIRIE VALLEY DENTAL, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KEVIN MICHAEL ENBERG D.D.S. (PRESIDENT)
(630) 365-1675
Entity
Organization
Contact information
Practice address
108 VALLEY DR UNIT H, ELBURN, IL 60119-8872
(630) 365-1675
(630) 365-1678
Mailing address
108 VALLEY DR UNIT H, ELBURN, IL 60119-8872
(630) 365-1675
(630) 365-1678
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
IL
Other
Enumeration date
08/24/2007
Last updated
08/24/2007
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