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Organization

SUGAR GROVE DENTAL ASSOCIATES,PC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. GLENN LOUIS DEWEIRDT DDS (PRESIDENT)
(630) 466-1100
Entity
Organization

Contact information

Practice address
495 N STATE ROUTE 47, SUITE J, SUGAR GROVE, IL 60554-8009
(630) 466-1100
(630) 466-7933
Mailing address
495 N STATE ROUTE 47, SUITE J, SUGAR GROVE, IL 60554-8009
(630) 466-1100
(630) 466-7933

Taxonomy

Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
019-019321
IL

Other

Enumeration date
12/03/2012
Last updated
12/03/2012
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