Organization
ADVANCED LISLE DENTAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
HETALKUMAR PATEL (OWNER)
(630) 890-6102
Entity
Organization
Contact information
Practice address
1046 MAPLE AVE, LISLE, IL 60532-2329
(630) 890-6102
Mailing address
1046 MAPLE AVE, LISLE, IL 60532-2329
Taxonomy
Speciality
Code
Description
License number
State
305R00000X
Preferred Provider Organization
Primary
019027403
IL
Other
Enumeration date
08/20/2013
Last updated
08/20/2013
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