Organization
ARTISTIC DENTAL CENTRE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ALBERT FITZ GRUBER JR. DMD (OWNER/PRESIDENT)
(708) 339-6800
Entity
Organization
Contact information
Practice address
15445 SOUTH PARK AVE, SOUTH HOLLAND, IL 60473-1302
(708) 339-6800
(708) 339-5567
Mailing address
15445 S PARK AVE, SOUTH HOLLAND, IL 60473-1302
(708) 339-6800
(708) 339-5567
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
019-019995
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1386714210
—
IL
Enumeration date
03/19/2012
Last updated
03/19/2012
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