Organization
PRAIRIE DENTAL OF OAK PARK LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
OSCAR G GONZALEZ (DIRECTOR OF OPERATIONS)
(219) 465-8627
Entity
Organization
Contact information
Practice address
1010 LAKE ST, OAK PARK, IL 60301-1147
(219) 465-8627
Mailing address
1010 LAKE ST, OAK PARK, IL 60301-1147
(219) 465-8627
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
—
—
Other
Enumeration date
07/19/2019
Last updated
07/19/2019
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