Organization
DR. JAY A WYGODNY DMD, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JAY A WYGODNY DMD (OWNER)
(847) 265-4420
Entity
Organization
Contact information
Practice address
2592 E GRAND AVE, SUITE 102, LINDENHURST, IL 60046-5915
(847) 265-4420
(847) 265-4429
Mailing address
2592 E GRAND AVE, SUITE 102, LINDENHURST, IL 60046-5915
(847) 265-4420
(847) 265-4429
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
019212
IL
Other
Enumeration date
09/24/2013
Last updated
09/24/2013
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