Organization
MEDCOA DENTAL CENTER PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
EUN SO (OWNER)
(847) 843-1170
Entity
Organization
Contact information
Practice address
1000 GRAND CANYON PARKWAY #308, HOFFMAN ESTATES, IL 60169-1705
(847) 843-1170
Mailing address
1000 GRAND CANYON PARKWAY #308, HOFFMAN ESTATES, IL 60169-1705
(847) 843-1170
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
019021947
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
019021947
—
IL
01
—
1619015062
INDIVIDUAL NPI NUMBER
—
Enumeration date
04/14/2015
Last updated
04/14/2015
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