Organization
FAIRFIELD DENTAL
Active
Parent organization
LAWRENCE DENTAL GROUP, P.C.
Organization subpart
Yes
Provider details
NPI number
Legal business name
LAWRENCE DENTAL GROUP, P.C.
Authorized official
DR. GEORGE KOROVILAS D.D.S. (PRESIDENT)
(773) 740-4100
Entity
Organization
Contact information
Practice address
732 N FAIRFIELD RD, ROUND LAKE, IL 60073-8160
(847) 740-4100
Mailing address
3607 W LAWRENCE AVE, CHICAGO, IL 60625-5605
(773) 588-7660
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
019023746
IL
Other
Enumeration date
12/22/2011
Last updated
12/22/2011
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