Dental On 45 INC

NPI #1184033839 in Third Lake, Illinois

Provider Information

NPI Number: 1184033839
Entity Type: Organization
Organization Name: Dental On 45 INC
Primary Specialty: Dentist
Enumeration Date: Aug 7, 2014
Last Updated: Aug 7, 2014

Practice Location

Address: 34484 N US HIGHWAY 45
Address 2: SUITE C
City: Third Lake
State: Illinois
ZIP Code: 60030-4038
Phone: (224) 541-4066

Authorized Official

Name: MRS. MARLEN FAJARDO
Title: OFFICE MANAGER
Phone: (224) 541-4066

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist	122300000X	Primary

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