Individual
DR. BRUCE ALAN LACOSTE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
555 W COURT ST, SUITE #102, KANKAKEE, IL 60901-3664
(815) 932-3822
(815) 937-3524
Mailing address
555 W COURT ST, SUITE #102, KANKAKEE, IL 60901-3664
(815) 932-3822
(815) 937-3524
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
IL
Other
Enumeration date
03/26/2007
Last updated
07/08/2007
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