Individual
JACOB G GROSELAK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
15531 E 127TH ST, LEMONT, IL 60439-8555
(630) 257-6350
Mailing address
7022 SIERRA DR, DARIEN, IL 60561-4040
(630) 841-9495
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
019.032102
IL
Other
Enumeration date
10/21/2019
Last updated
10/21/2019
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