| Heritage Dental | |
|
800 Main St Antioch IL 60002-1542 | |
| (847) 395-1461 | |
| (847) 395-9255 |
| Full Name | Heritage Dental |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 800 Main St, Antioch, Illinois |
| Authorized Official Name and Position | Kenneth Jazdzewski (OFFICER OF CORPORATION) |
| Authorized Official Contact | 8473951461 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Heritage Dental 800 Main St Antioch IL 60002-1542 Ph: (847) 395-1461 | Heritage Dental 800 Main St Antioch IL 60002-1542 Ph: (847) 395-1461 |
| NPI Number | 1356490700 |
|---|---|
| Provider Enumeration Date | 01/08/2007 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1356490700 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (* (Not Available)) | Primary |
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