Organization
PERIODONTAL MEDICINE AND SURGICAL SPECIALISTS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MOLLY WALSH (PRACTICE OPERATIONS DIRECTOR)
(630) 627-3930
Entity
Organization
Contact information
Practice address
2300 LEHIGH AVE STE 210, GLENVIEW, IL 60026-1691
(630) 627-3930
Mailing address
1S224 SUMMIT AVE STE 205, OAKBROOK TERRACE, IL 60181-3943
(630) 627-3930
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
Primary
—
—
261QD0000X
Dental Clinic/Center
—
—
Other
Enumeration date
03/04/2022
Last updated
03/04/2022
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