Organization
CRESTWOOD DENTAL AND TMJ CARE PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KEVIN BARGAMIAN (PRESIDENT)
(708) 388-3200
Entity
Organization
Contact information
Practice address
13549 CICERO AVE, CRESTWOOD, IL 60445-1934
(708) 388-3200
Mailing address
13549 CICERO AVE, CRESTWOOD, IL 60445-1934
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
019024802
IL
332BC3200X
Customized Equipment (DME)
—
IL
Other
Enumeration date
09/01/2015
Last updated
08/08/2016
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