| Associated Dental Specialists Of Long Grove Ltd | |
|
Rfd 4160 Grove Medical Center Suite 308 Long Grove IL 60047-9586 | |
| (847) 634-6166 | |
| (846) 634-6302 |
| Full Name | Associated Dental Specialists Of Long Grove Ltd |
|---|---|
| Speciality | Dentist - Pediatric Dentistry |
| Location | Rfd 4160, Long Grove, Illinois |
| Authorized Official Name and Position | Mark L Cannon (PRESIDENT) |
| Authorized Official Contact | 8476346166 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Associated Dental Specialists Of Long Grove Ltd Rfd 4160 Grove Medical Center Suite 308 Long Grove IL 60047-9586 Ph: (847) 634-6166 | Associated Dental Specialists Of Long Grove Ltd Rfd 4160 Grove Medical Center Suite 308 Long Grove IL 60047-9586 Ph: (847) 634-6166 |
| NPI Number | 1033383567 |
|---|---|
| Provider Enumeration Date | 04/16/2008 |
| Last Update Date | 04/16/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1033383567 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0221X | Dentist - Pediatric Dentistry | 060.003411019.021533 (Illinois) | Primary |
Robert Villa Dds, Pllc Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 5471 Rfd, Long Grove, IL 60047 Phone: 847-668-3876 | |
Associated Dental Specialists Of Long Grove Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 4160 Il Route 83 Ste 308, Long Grove, IL 60047 Phone: 847-634-6166 | |
Long Grove Dental Studio Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 3976 Route 22, Suite E, Long Grove, IL 60047 Phone: 847-719-1973 Fax: 847-719-1975 |