Individual
DR. DONALD JOSEPH PROVENZALE JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
4336 SARATOGA AVE, DOWNERS GROVE, IL 60515-2866
(630) 969-7711
(630) 969-7723
Mailing address
4336 SARATOGA AVE, DOWNERS GROVE, IL 60515-2866
(630) 969-7711
(630) 969-7723
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
19O21170
IL
Other
Enumeration date
08/27/2009
Last updated
08/27/2009
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