Organization
MODERN DENTAL OF LOGAN SQUARE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PHILLIP PALELLA DDS (OWNER)
(773) 489-5700
Entity
Organization
Contact information
Practice address
2645 N MILWAUKEE, CHICAGO, IL 60647
(773) 717-5509
Mailing address
2037 W DIVISION, CHICAGO, IL 60622
(773) 489-5700
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
019026403
IL
Other
Enumeration date
08/31/2016
Last updated
08/31/2016
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