Organization
PROFESSIONAL DENTAL ALLIANCE OF ILLINOIS ORTHO PLLC
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) 410-1766
Mailing address
11 S MILL ST STE 200, NEW CASTLE, PA 16101-3680
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
03/17/2020
Last updated
03/17/2020
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