Providence Family Dental | |
3091 W. Route 20 #103 Elgin IL 60124 | |
(847) 841-1555 | |
Not Available |
Full Name | Providence Family Dental |
---|---|
Speciality | Dentist - General Practice |
Location | 3091 W. Route 20, Elgin, Illinois |
Authorized Official Name and Position | Siri Chanthasalo (PRESIDENT) |
Authorized Official Contact | 8472177215 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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Providence Family Dental 452 Westport Dr Pingree Grove IL 60140-9172 Ph: (847) 217-7215 | Providence Family Dental 3091 W. Route 20 #103 Elgin IL 60124 Ph: (847) 841-1555 |
NPI Number | 1114178183 |
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Provider Enumeration Date | 10/08/2008 |
Last Update Date | 10/08/2008 |
Identifier | Type | State | Issuer |
---|---|---|---|
1114178183 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
1223G0001X | Dentist - General Practice | 019.025831 (Illinois) | Primary |
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