Addison Dental | |
1201 W Army Trail Blvd Suite 2 Addison IL 60101-3152 | |
(630) 543-8688 | |
(630) 543-8692 |
Full Name | Addison Dental |
---|---|
Speciality | Dentist - Oral And Maxillofacial Surgery |
Location | 1201 W Army Trail Blvd, Addison, Illinois |
Authorized Official Name and Position | Lawrence Groh (OWNER/PRESIDENT) |
Authorized Official Contact | 6308335110 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
---|---|
Addison Dental 333 W 1st St Elmhurst IL 60126-2641 Ph: (630) 833-5110 | Addison Dental 1201 W Army Trail Blvd Suite 2 Addison IL 60101-3152 Ph: (630) 543-8688 |
NPI Number | 1073954723 |
---|---|
Provider Enumeration Date | 07/10/2013 |
Last Update Date | 07/10/2013 |
Identifier | Type | State | Issuer |
---|---|---|---|
1073954723 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
1223S0112X | Dentist - Oral And Maxillofacial Surgery | 019014858 (Illinois) | Primary |
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