Organization
DENTAL PROFILE 2
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MILAN RONCEVIC (GENERAL MANAGER)
(630) 516-0000
Entity
Organization
Contact information
Practice address
120 E LAKE ST, ADDISON, IL 60101-2821
(630) 530-2498
(630) 530-2689
Mailing address
120 E LAKE ST, ADDISON, IL 60101-2821
(630) 530-2498
(630) 530-2689
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
IL
Other
Enumeration date
03/13/2008
Last updated
03/13/2008
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