Organization
LISLE DENTAL SPECIALISTS,INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DOUGLAD CHANG DDS (OWNER)
(630) 747-7778
Entity
Organization
Contact information
Practice address
6070 STATE ROUTE 53, LISLE, IL 60532-3395
(630) 426-7365
(630) 963-9344
Mailing address
6070 STATE ROUTE 53, LISLE, IL 60532-3395
(630) 426-7365
(630) 963-9344
Taxonomy
Speciality
Code
Description
License number
State
1223E0200X
Endodontics
—
—
1223P0300X
Periodontics
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1588977516
ENDODONTIST
IL
01
—
1639958010
PERIODONTIST
IL
Enumeration date
07/10/2024
Last updated
07/10/2024
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