Organization
LAGRANGE PERIO LLC
Active
Other names
Lagrange Periodontics
Organization subpart
No
Provider details
NPI number
Authorized official
TIFFANY JENSEN (MANAGER)
(708) 354-4545
Entity
Organization
Contact information
Practice address
6520 JOLIET RD, COUNTRYSIDE, IL 60525-4649
(708) 354-4545
Mailing address
6520 JOLIET RD, COUNTRYSIDE, IL 60525-4649
(708) 354-4545
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
Primary
—
—
Other
Enumeration date
09/15/2022
Last updated
09/15/2022
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