Organization
D J PROVENZALE & D J PROVENZALE JR
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DONALD J PROVENZALE JR. DDS (PARTNER)
(630) 969-7711
Entity
Organization
Contact information
Practice address
4336 SARATOGA AVE, DOWNERS GROVE, IL 60515
(630) 969-7711
(630) 969-7723
Mailing address
4336 SARATOGA AVE, DOWNERS GROVE, IL 60515
(630) 969-7711
(630) 969-7723
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
19021170
IL
1223G0001X
General Practice Dentistry
19A12314
IL
Other
Enumeration date
05/03/2007
Last updated
08/22/2020
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