| Foster Avenue Dental Clinic P.c. | |
|
1400 E Golf Rd Suite 125 Des Plaines IL 60016-1236 | |
| (847) 827-7990 | |
| (847) 827-7852 |
| Full Name | Foster Avenue Dental Clinic P.c. |
|---|---|
| Speciality | Dentist |
| Location | 1400 E Golf Rd, Des Plaines, Illinois |
| Authorized Official Name and Position | Gregory H Tietzer (OWNER) |
| Authorized Official Contact | 7734638860 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Foster Avenue Dental Clinic P.c. 3318 W Foster Ave Chicago IL 60625-4813 Ph: (773) 463-8860 | Foster Avenue Dental Clinic P.c. 1400 E Golf Rd Suite 125 Des Plaines IL 60016-1236 Ph: (847) 827-7990 |
| NPI Number | 1205133527 |
|---|---|
| Provider Enumeration Date | 02/23/2011 |
| Last Update Date | 02/23/2011 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1205133527 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 019019206 (Illinois) | Primary |
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