Organization
PREMIER DENTAL GROUP PERSONAL CORPORATION
Active
Other names
West Willow Family Dental
Organization subpart
No
Provider details
NPI number
Authorized official
ANTHONY AMODIO BRUCCI DMD (DENTIST/OWNER)
(708) 308-9929
Entity
Organization
Contact information
Practice address
300 S WEST ST, WHEATON, IL 60187-5021
(630) 665-0650
(708) 484-0843
Mailing address
183 N ADDISON AVE APT 216, ELMHURST, IL 60126-3195
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
—
—
1223G0001X
General Practice Dentistry
—
—
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
04/21/2023
Last updated
04/25/2023
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