| Placida | |
|
217 S Bolingbrook Dr Bolingbrook IL 60440-2931 | |
| (630) 313-4918 | |
| (630) 626-4784 |
| Full Name | Placida |
|---|---|
| Speciality | Dentist |
| Location | 217 S Bolingbrook Dr, Bolingbrook, Illinois |
| Authorized Official Name and Position | Deepa Sridhar (PRESIDENT) |
| Authorized Official Contact | 6303134918 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Placida 217 S Bolingbrook Dr Bolingbrook IL 60440-2931 Ph: (630) 313-4918 | Placida 217 S Bolingbrook Dr Bolingbrook IL 60440-2931 Ph: (630) 313-4918 |
| NPI Number | 1659762631 |
|---|---|
| Provider Enumeration Date | 02/11/2015 |
| Last Update Date | 02/11/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1659762631 | NPI | - | NPPES |
| 9178432 | Medicaid | IL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 019026471 (Illinois) | Primary |
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