| Corporation | |
|
148 Addison Ave Elmhurst IL 60126-2810 | |
| (630) 530-4808 | |
| Not Available |
| Full Name | Corporation |
|---|---|
| Speciality | Dentist - Endodontics |
| Location | 148 Addison Ave, Elmhurst, Illinois |
| Authorized Official Name and Position | Donald Christie Beard (PRESIDENT) |
| Authorized Official Contact | 6305304808 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Corporation 148 Addison Ave Elmhurst IL 60126-2810 Ph: (630) 530-4808 | Corporation 148 Addison Ave Elmhurst IL 60126-2810 Ph: (630) 530-4808 |
| NPI Number | 1366500159 |
|---|---|
| Provider Enumeration Date | 12/05/2006 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1366500159 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223E0200X | Dentist - Endodontics | (Illinois) | Primary |
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