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Organization

DENTAL ASSOCIATES OF ALSIP, LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
KATHERINE GRUENEBERG (CHIEF ADMINISTRATIVE OFFICER)
(414) 778-5274
Entity
Organization

Contact information

Practice address
5061 WEST 111TH ST., ALSIP, IL 60803-6074
(708) 422-6655
(708) 422-0628
Mailing address
3333 N MAYFAIR RD, SUITE 311, WAUWATOSA, WI 53222-3219
(414) 808-3031
(414) 808-3098

Taxonomy

Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
IL

Other

Enumeration date
05/12/2017
Last updated
05/12/2017
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