| Professional Dental Alliance Of Grove Dental Specialty Llc | |
|
160 E Boughton Rd Bolingbrook IL 60440-2014 | |
| (630) 410-1766 | |
| Not Available |
| Full Name | Professional Dental Alliance Of Grove Dental Specialty Llc |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 160 E Boughton Rd, Bolingbrook, Illinois |
| Authorized Official Name and Position | Amanda Kurtz (CREDENTIALING SPECIALIST) |
| Authorized Official Contact | 7246982058 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Professional Dental Alliance Of Grove Dental Specialty Llc Po Box 715279 Cincinnati OH 45271-5279 Ph: () - | Professional Dental Alliance Of Grove Dental Specialty Llc 160 E Boughton Rd Bolingbrook IL 60440-2014 Ph: (630) 410-1766 |
| NPI Number | 1215563762 |
|---|---|
| Provider Enumeration Date | 03/17/2020 |
| Last Update Date | 04/28/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1215563762 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | (* (Not Available)) | Primary |
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