| Long Grove Dental Studio | |
|
3976 Route 22 Suite E Long Grove IL 60047 | |
| (847) 719-1973 | |
| (847) 719-1975 |
| Full Name | Long Grove Dental Studio |
|---|---|
| Speciality | Dentist |
| Location | 3976 Route 22, Long Grove, Illinois |
| Authorized Official Name and Position | Nichole Lee Demars (OWNER/DENTIST) |
| Authorized Official Contact | 8477191973 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Long Grove Dental Studio 3976 Route 22 Suite E Long Grove IL 60047 Ph: (847) 719-1973 | Long Grove Dental Studio 3976 Route 22 Suite E Long Grove IL 60047 Ph: (847) 719-1973 |
| NPI Number | 1568751436 |
|---|---|
| Provider Enumeration Date | 03/31/2011 |
| Last Update Date | 03/31/2011 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1568751436 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 019025986 (Illinois) | Primary |
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