Organization
PERIODONTICS & IMPLANTS, LTD.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RICHARD C PRENDERGAST D.D.S., M.S. (PRESIDENT/PERIODONTIST)
(847) 491-1880
Entity
Organization
Contact information
Practice address
636 CHURCH ST, SUITE 707, EVANSTON, IL 60201-4508
(847) 491-1880
Mailing address
636 CHURCH ST, SUITE 707, EVANSTON, IL 60201-4508
(847) 491-1880
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
Primary
021000596
IL
Other
Enumeration date
09/30/2008
Last updated
09/30/2008
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