Organization
DENTAL PROFESSIONALS OF ILLINOIS, PC
Active
Parent organization
DENTAL PROFESSIONALS OF ILLINOIS, PC
Other names
Porter Dental Center
Organization subpart
Yes
Provider details
NPI number
Legal business name
DENTAL PROFESSIONALS OF ILLINOIS, PC
Authorized official
KENDRA WALKER (CREDENTIALING TEAM LEAD)
(217) 540-8312
Entity
Organization
Contact information
Practice address
16620 W 159TH ST, LOCKPORT, IL 60441-8012
(815) 306-4275
Mailing address
16620 W 159TH ST, LOCKPORT, IL 60441-8012
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
04/05/2016
Last updated
04/05/2016
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