| Dentist At Your Door Llc | |
|
19512 Sequoia Ave Lynwood IL 60411-6825 | |
| (708) 828-8637 | |
| Not Available |
| Full Name | Dentist At Your Door Llc |
|---|---|
| Speciality | Dentist |
| Location | 19512 Sequoia Ave, Lynwood, Illinois |
| Authorized Official Name and Position | Shanda Lolita Bundy-smith (DENTIST) |
| Authorized Official Contact | 7088288637 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Dentist At Your Door Llc 19512 Sequoia Ave Lynwood IL 60411-6825 Ph: (708) 828-8637 | Dentist At Your Door Llc 19512 Sequoia Ave Lynwood IL 60411-6825 Ph: (708) 828-8637 |
| NPI Number | 1487810685 |
|---|---|
| Provider Enumeration Date | 08/06/2008 |
| Last Update Date | 08/06/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1487810685 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 019023785 (Illinois) | Primary |