DENTAL PROFILE 2 NPI 1477724870

NPI Information

DENTAL PROFILE 2 is a general practice dentist in Addison, IL. The provider is a general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs. DENTAL PROFILE 2 NPI is 1477724870. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

120 E LAKE ST
ADDISON, IL
ZIP 60101-821
Phone: (630) 530-2498
Fax: (630) 530-2689

The provider's authorized official is Milan Roncevic .
The authorized official title is General Manager and has the following contact phone number (630) 516-0000.

The enumeration date for this NPI number is 3/13/2008 and was last updated on 3/13/2008.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

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