Organization
PERIODONTAL MEDICINE AND SURGICAL SPECIALISTS, LLC
Active
Other names
Periodontal Medicine and Surgical Specialists, LTD
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GEORGE A MANDELARIS DDS (OWNER PERIODONTIST)
(630) 627-3930
Entity
Organization
Contact information
Practice address
1875 DEMPSTER ST, SUITE 250, PARK RIDGE, IL 60068-1186
(847) 698-1180
(847) 698-1185
Mailing address
1S224 SUMMIT AVE, SUITE 205, OAKBROOK TERRACE, IL 60181-3983
(630) 627-3930
(630) 627-2148
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
019014972
IL
1223P0300X
Periodontics
Primary
019024971
IL
1223P0300X
Periodontics
019030200
IL
124Q00000X
Dental Hygienist
020005282
IL
Other
Enumeration date
02/06/2007
Last updated
12/29/2016
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