Organization
DENTAL ASSOCIATES OF SOUTH RIDGE, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. PRIYADARSHINI BOINPALLY DDS (PRESIDENT)
(847) 625-9897
Entity
Organization
Contact information
Practice address
6121 WASHINGTON ST, #202, GURNEE, IL 60031-5305
(847) 625-9897
Mailing address
483 EVERGREEN DR, VERNON HILLS, IL 60061-2907
(847) 625-9897
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
019028057
IL
Other
Enumeration date
09/01/2016
Last updated
09/01/2016
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