| Professional Dental Alliance Of Illinois Ortho Pllc | |
|
160 E Boughton Rd Bolingbrook IL 60440-2014 | |
| (630) 410-1766 | |
| Not Available |
| Full Name | Professional Dental Alliance Of Illinois Ortho Pllc |
|---|---|
| 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 Illinois Ortho Pllc 11 S Mill St Ste 200 New Castle PA 16101-3680 Ph: () - | Professional Dental Alliance Of Illinois Ortho Pllc 160 E Boughton Rd Bolingbrook IL 60440-2014 Ph: (630) 410-1766 |
| NPI Number | 1457987901 |
|---|---|
| Provider Enumeration Date | 03/17/2020 |
| Last Update Date | 03/17/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1457987901 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | (* (Not Available)) | Primary |
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