Foster Avenue Dental Clinic P.c.
NPI #1205133527 in Des Plaines, Illinois
Provider Information
- NPI Number
- 1205133527
- Entity Type
- Organization
- Organization Name
- Foster Avenue Dental Clinic P.c.
- Primary Specialty
- Dentist
- Enumeration Date
- Feb 23, 2011
- Last Updated
- Feb 23, 2011
Practice Location
- Address
- 1400 E GOLF RD
- Address 2
- SUITE 125
- City
- Des Plaines
- State
- Illinois
- ZIP Code
- 60016-1236
- Phone
- (847) 827-7990
Authorized Official
- Name
- DR. GREGORY H TIETZER, D.D.S.
- Title
- OWNER
- Phone
- (773) 463-8860
Specialties & Taxonomy Codes
| Specialty |
|---|
| Dentist |
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