Organization
PROFESSIONAL DENTAL ALLIANCE OF GROVE DENTAL LLC
Active
Other names
Grove Dental
Organization subpart
No
Provider details
NPI number
Authorized official
AMANDA KURTZ (CREDENTIALING SPECIALIST)
(724) 698-2058
Entity
Organization
Contact information
Practice address
160 E BOUGHTON RD, BOLINGBROOK, IL 60440-2014
(630) 759-8940
Mailing address
PO BOX 715279, CINCINNATI, OH 45271-5279
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
03/20/2020
Last updated
04/29/2021
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