Individual
DR. MARK JAMES BROOMHEAD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
615 E 162ND ST, SOUTH HOLLAND, IL 60473-2329
(773) 817-5500
Mailing address
615 E 162ND ST, SOUTH HOLLAND, IL 60473-2329
(773) 817-5500
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
019026740
IL
Other
Enumeration date
07/22/2013
Last updated
07/22/2013
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