Professional Dental Alliance of Illinois Specialty, Pllc
NPI #1558145227 in Long Grove, Illinois
Provider Information
- NPI Number
- 1558145227
- Entity Type
- Organization
- Organization Name
- Professional Dental Alliance of Illinois Specialty, Pllc
- Primary Specialty
- Dentist - Pediatric Dentistry
- Enumeration Date
- Aug 23, 2023
- Last Updated
- Dec 13, 2023
Practice Location
- Address
- 4160 IL ROUTE 83 STE 308
- City
- Long Grove
- State
- Illinois
- ZIP Code
- 60047-8034
- Phone
- (847) 634-6166
Authorized Official
- Name
- ERICA QUINTEROS
- Title
- CREDENTIALING
- Phone
- (724) 901-1964
Specialties & Taxonomy Codes
| Specialty |
|---|
| Dentist - General Practice — General Practice |
| Dentist - Orthodontics and Dentofacial Orthopedics — Orthodontics and Dentofacial Orthopedics |
| Dentist - Pediatric Dentistry — Pediatric Dentistry |
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