| Mallard Dental Inc | |
|
33 S Addison Rd Ste 101 Addison IL 60101-3868 | |
| (630) 834-4343 | |
| (630) 834-6308 |
| Full Name | Mallard Dental Inc |
|---|---|
| Speciality | Dentist - Pediatric Dentistry |
| Location | 33 S Addison Rd, Addison, Illinois |
| Authorized Official Name and Position | Konstadina Anastasia Aralles (PRESIDENT) |
| Authorized Official Contact | 6308344343 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Mallard Dental Inc 33 S Addison Rd Ste 101 Addison IL 60101-3868 Ph: (630) 834-4343 | Mallard Dental Inc 33 S Addison Rd Ste 101 Addison IL 60101-3868 Ph: (630) 834-4343 |
| NPI Number | 1467437756 |
|---|---|
| Provider Enumeration Date | 12/09/2005 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1467437756 | NPI | - | NPPES |
| 103045 | Medicaid | IL | |
| 1001079 | Medicaid | IL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0221X | Dentist - Pediatric Dentistry | (Illinois) | Primary |
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