Organization
ARTISAN DENTAL GROUP OF ILLINOIS LLC
Active
Other names
ARTISAN DENTAL GROUP
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DONNA MADDALOZZO DDS, M.S. (PRESIDENT/CO-OWNER)
(847) 934-4280
Entity
Organization
Contact information
Practice address
649 N 1ST BANK DR, PALATINE, IL 60067-8111
(847) 934-4200
(847) 934-4294
Mailing address
649 N 1ST BANK DR, PALATINE, IL 60067-8111
(847) 934-4200
(847) 934-4294
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
019019847
IL
1223G0001X
General Practice Dentistry
019019961
IL
1223G0001X
General Practice Dentistry
019021223
IL
1223P0300X
Periodontics
021001354
IL
1223P0300X
Periodontics
021001430
IL
1223P0300X
Periodontics
021001510
IL
Other
Enumeration date
12/21/2016
Last updated
12/21/2016
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