Organization
SOUTH PARK DENTAL CARE
Active
Parent organization
SOUTH PARK DENTAL CARE
Other names
Harvey Dental Associates
Organization subpart
Yes
Provider details
NPI number
Legal business name
SOUTH PARK DENTAL CARE
Authorized official
DR. KENNETH O JOHNSON (PRESIDENT)
(708) 335-4387
Entity
Organization
Contact information
Practice address
438 E 162ND ST, SOUTH HOLLAND, IL 60473-2258
(708) 333-0699
Mailing address
438 E 162ND ST, SOUTH HOLLAND, IL 60473-2258
(708) 333-0699
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
019018099
IL
Other
Enumeration date
07/17/2008
Last updated
07/17/2008
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