Sugar Grove Dental Associates,p.c.

NPI #1861684300 in Sugar Grove, Illinois

Provider Information

NPI Number: 1861684300
Entity Type: Organization
Organization Name: Sugar Grove Dental Associates,p.c.
Primary Specialty: Dentist - General Practice
Enumeration Date: Aug 17, 2007
Last Updated: Aug 17, 2007

Practice Location

Address: 495 NORTH ROUTE 47
Address 2: SUITE J
City: Sugar Grove
State: Illinois
ZIP Code: 60554
Phone: (630) 466-1100

Authorized Official

Name: DR. GLENN LOUIS DEWEIRDT JR., D.D.S.
Title: PRESIDENT
Phone: (630) 466-1100

Specialties & Taxonomy Codes

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

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