Organization
IMAGE DENTISTRY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. JACY L GAYLORD (MANAGER)
(847) 804-5229
Entity
Organization
Contact information
Practice address
2450 GRASS LAKE RD, SUITE C, LINDENHURST, IL 60046-5613
(847) 265-9022
(847) 265-9023
Mailing address
830 W STATE ROUTE 22 # 49, LAKE ZURICH, IL 60047-2560
(847) 265-9022
(847) 265-9023
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
019022864
IL
Other
Enumeration date
08/04/2016
Last updated
08/04/2016
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