Organization
NILES DENTAL CARE P.C.
Active
Other names
Niles dental care p.c.
Organization subpart
No
Provider details
NPI number
Authorized official
ROBERT ARTHUR SANDUSKY DDS (PRESIDENT)
(847) 470-0240
Entity
Organization
Contact information
Practice address
8031 N MILWAUKEE AVE, NILES, IL 60714-2827
(847) 470-0240
Mailing address
8031 N MILWAUKEE AVE, NILES, IL 60714-2827
(847) 470-0240
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
—
IL
124Q00000X
Dental Hygienist
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1205056413
—
IL
Enumeration date
11/29/2016
Last updated
11/29/2016
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