Organization
D2 DENTAL OF ILLINOIS, P.C.
Active
Other names
Destiny Dental
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JASON M GRINTER (PRESIDENT)
(773) 369-5428
Entity
Organization
Contact information
Practice address
712 E 87TH ST, SUITE D, CHICAGO, IL 60619-6246
(708) 386-4800
Mailing address
137 N OAK PARK AVE, SUITE 200, OAK PARK, IL 60301-1344
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
—
—
Other
Enumeration date
07/15/2010
Last updated
07/15/2010
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