Organization
PALOS PEDIATRIC DENTISTRY, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RICHARD NORMAN FACKO DDS, MS (PRESIDENT)
(708) 280-9234
Entity
Organization
Contact information
Practice address
12800 S RIDGELAND AVE, SUITE H, PALOS HEIGHTS, IL 60463-2390
(708) 280-9234
Mailing address
12800 S RIDGELAND AVE, SUITE H, PALOS HEIGHTS, IL 60463-2390
(708) 280-9234
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
019028264
IL
Other
Enumeration date
08/12/2013
Last updated
08/12/2013
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