Marengo Dental

NPI #1760608731 in Marengo, Illinois

Provider Information

NPI Number: 1760608731
Entity Type: Organization
Organization Name: Marengo Dental
Primary Specialty: Dentist - General Practice
Enumeration Date: Apr 18, 2007
Last Updated: Sep 9, 2008

Practice Location

Address: 110 E WASHINGTON ST
City: Marengo
State: Illinois
ZIP Code: 60152-3107
Phone: (815) 568-1202

Authorized Official

Name: DR. GARY DETTMAN
Title: PRESIDENT
Phone: (815) 568-1202

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist - General Practice — General Practice	1223G0001X	Primary

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