| Apollo Dental Clinic, Llc | |
|
6121 Washington St Suite 203 Gurnee IL 60031-5305 | |
| (630) 267-4205 | |
| (630) 477-0447 |
| Full Name | Apollo Dental Clinic, Llc |
|---|---|
| Speciality | Dentist |
| Location | 6121 Washington St, Gurnee, Illinois |
| Authorized Official Name and Position | Sumrana S Ahmed (MEMBER) |
| Authorized Official Contact | 6302674205 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Apollo Dental Clinic, Llc 6121 Washington St Suite 203 Gurnee IL 60031-5305 Ph: (630) 267-4205 | Apollo Dental Clinic, Llc 6121 Washington St Suite 203 Gurnee IL 60031-5305 Ph: (630) 267-4205 |
| NPI Number | 1083937742 |
|---|---|
| Provider Enumeration Date | 03/10/2010 |
| Last Update Date | 03/10/2010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1083937742 | NPI | - | NPPES |
| 1005798 | Medicaid | IL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 019026293 (Illinois) | Primary |
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