Organization
DENTIST AT YOUR DOOR LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SHANDA LOLITA BUNDY-SMITH D.D.S. (DENTIST)
(708) 828-8637
Entity
Organization
Contact information
Practice address
19512 SEQUOIA AVE, LYNWOOD, IL 60411-6825
(708) 828-8637
Mailing address
19512 SEQUOIA AVE, LYNWOOD, IL 60411-6825
(708) 828-8637
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
019023785
IL
Other
Enumeration date
08/06/2008
Last updated
08/06/2008
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