Organization
PROFESSIONAL DENTAL ALLIANCE OF ILLINOIS SPECIALTY, PLLC
Active
Other names
Associated Dental Specialists of Long Grove
Organization subpart
No
Provider details
NPI number
Authorized official
ERICA QUINTEROS (CREDENTIALING)
(724) 901-1964
Entity
Organization
Contact information
Practice address
4160 IL ROUTE 83 STE 308, LONG GROVE, IL 60047-8034
(847) 634-6166
Mailing address
125 ENTERPRISE DR STE 200, PITTSBURGH, PA 15275-1223
(249) 011-9647
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
—
—
1223P0221X
Pediatric Dentistry
Primary
—
—
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
—
—
Other
Enumeration date
08/23/2023
Last updated
12/13/2023
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