Organization
LAKE FOREST PEDIATIC DENTISTRY, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOSEPH GORDON D.D.S. (PEDIATRIC DENTIST, PRESIDENT)
(847) 482-1900
Entity
Organization
Contact information
Practice address
500 N WESTERN AVE, SUITE 215, LAKE FOREST, IL 60045-1954
(847) 482-1900
Mailing address
500 N WESTERN AVE, SUITE 215, LAKE FOREST, IL 60045-1954
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
019024258
IL
Other
Enumeration date
07/25/2014
Last updated
07/25/2014
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