| Grand Yeoman Park Dental Care | |
|
11316 W Wadsworth Rd Beach Park IL 60099-3367 | |
| (847) 872-5530 | |
| (847) 872-1683 |
| Full Name | Grand Yeoman Park Dental Care |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 11316 W Wadsworth Rd, Beach Park, Illinois |
| Authorized Official Name and Position | Tayseer Ahmed Ibrahim (PRESIDENT) |
| Authorized Official Contact | 8478725530 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Grand Yeoman Park Dental Care 1413 Grand Ave Waukegan IL 60085-3601 Ph: (847) 244-3322 | Grand Yeoman Park Dental Care 11316 W Wadsworth Rd Beach Park IL 60099-3367 Ph: (847) 872-5530 |
| NPI Number | 1043209257 |
|---|---|
| Provider Enumeration Date | 10/19/2005 |
| Last Update Date | 01/22/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1043209257 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 19-025457 (Illinois) | Primary |
Wadsworth Dental Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 11316 W Wadsworth Rd, Beach Park, IL 60099 Phone: 847-872-5530 Fax: 847-872-1683 |