Professional Dental Alliance of Grove Dental Specialty LLC
NPI #1215563762 in Bolingbrook, Illinois
Provider Information
- NPI Number
- 1215563762
- Entity Type
- Organization
- Organization Name
- Professional Dental Alliance of Grove Dental Specialty LLC
- Primary Specialty
- Clinic/Center - Dental
- Enumeration Date
- Mar 17, 2020
- Last Updated
- Apr 28, 2021
Practice Location
- Address
- 160 E BOUGHTON RD
- City
- Bolingbrook
- State
- Illinois
- ZIP Code
- 60440-2014
- Phone
- (630) 410-1766
Authorized Official
- Name
- AMANDA KURTZ
- Title
- CREDENTIALING SPECIALIST
- Phone
- (724) 698-2058
Specialties & Taxonomy Codes
| Specialty |
|---|
| Clinic/Center - Dental — Dental |
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