| Lary M. Pane, D.d.s.,p.c. | |
|
4420 Saint Charles Rd Bellwood IL 60104-1157 | |
| (708) 547-7160 | |
| (630) 426-0211 |
| Full Name | Lary M. Pane, D.d.s.,p.c. |
|---|---|
| Speciality | Dentist |
| Location | 4420 Saint Charles Rd, Bellwood, Illinois |
| Authorized Official Name and Position | Lary M Pane (PRESIDENT) |
| Authorized Official Contact | 7085477160 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Lary M. Pane, D.d.s.,p.c. 4420 Saint Charles Rd Bellwood IL 60104-1157 Ph: (708) 547-7160 | Lary M. Pane, D.d.s.,p.c. 4420 Saint Charles Rd Bellwood IL 60104-1157 Ph: (708) 547-7160 |
| NPI Number | 1003080136 |
|---|---|
| Provider Enumeration Date | 04/18/2008 |
| Last Update Date | 04/18/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1003080136 | NPI | - | NPPES |
| 1005522 | Medicaid | IL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 01901546 (Illinois) | Primary |
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