Organization
HEALTHY TOOTH DENTAL, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. EDWARD D LOPEZ (PRESIDENT)
(708) 386-3200
Entity
Organization
Contact information
Practice address
719 LAKE ST, OAK PARK, IL 60301-1406
(708) 386-3200
(708) 386-3206
Mailing address
719 LAKE ST, OAK PARK, IL 60301-1406
(708) 386-3200
(708) 386-3206
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
019027665
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1861651622
—
IL
Enumeration date
09/21/2009
Last updated
12/03/2013
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