Organization
ELLEN E TKACH, D.D.S., P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ELLEN E TKACH D.D.S. (CEO/PRESIDENT)
(847) 431-4416
Entity
Organization
Contact information
Practice address
1029 HOWARD ST STE 201, EVANSTON, IL 60202-3877
(847) 431-4416
Mailing address
1029 HOWARD ST STE 201, EVANSTON, IL 60202-3877
(847) 431-4416
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
019021157
IL
Other
Enumeration date
09/18/2013
Last updated
09/18/2013
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