Organization
PEDIATRIC AND FAMILY DENT
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SCOTT GOLDMAN (PRESIDENT)
(312) 310-4543
Entity
Organization
Contact information
Practice address
38 PLYMOUTH CT, LINCOLNSHIRE, IL 60069-3157
(312) 310-4543
Mailing address
38 PLYMOUTH CT, LINCOLNSHIRE, IL 60069-3157
(312) 310-4543
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
019027333
IL
Other
Enumeration date
07/02/2012
Last updated
07/02/2012
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