Organization
MADISON STREET DENTAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KRISTY WOLTER (INSURANCE MANAGER)
(630) 339-3172
Entity
Organization
Contact information
Practice address
210 N MADISON ST, WOODSTOCK, IL 60098-3450
(815) 338-7569
Mailing address
1699 E WOODFIELD RD STE 102, SCHAUMBURG, IL 60173-4955
(630) 339-3172
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
019015666
IL
261QD0000X
Dental Clinic/Center
019018403
IL
Other
Enumeration date
12/04/2017
Last updated
12/04/2017
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