Illinois Dental Providers (glen Ellyn), Ltd
NPI #1306217252 in Glen Ellyn, Illinois
Provider Information
- NPI Number
- 1306217252
- Entity Type
- Organization
- Organization Name
- Illinois Dental Providers (glen Ellyn), Ltd
- Subpart
- Yes (part of a larger organization)
- Parent Organization
- DENTALONE PARTNERS, INC.
- Primary Specialty
- Dentist - General Practice
- Enumeration Date
- Oct 16, 2015
- Last Updated
- Mar 20, 2018
Practice Location
- Address
- 701 ROOSEVELT RD
- City
- Glen Ellyn
- State
- Illinois
- ZIP Code
- 60137-5805
- Phone
- (630) 790-8430
Authorized Official
- Name
- RACHEL NITTINGER
- Title
- MANAGER CREDENTIALING
- Phone
- (972) 755-0816
Specialties & Taxonomy Codes
| Specialty |
|---|
| Dentist - General Practice — General Practice |
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