| Autumn Dental Of Mokena Llc | |
|
19848 S La Grange Rd Mokena IL 60448-9339 | |
| (708) 995-1859 | |
| Not Available |
| Full Name | Autumn Dental Of Mokena Llc |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 19848 S La Grange Rd, Mokena, Illinois |
| Authorized Official Name and Position | Scott Bares (OWNER) |
| Authorized Official Contact | 8152752680 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Autumn Dental Of Mokena Llc 208 N Walnut Ave Forreston IL 61030-9330 Ph: (815) 938-2575 | Autumn Dental Of Mokena Llc 19848 S La Grange Rd Mokena IL 60448-9339 Ph: (708) 995-1859 |
| NPI Number | 1427576750 |
|---|---|
| Provider Enumeration Date | 09/07/2017 |
| Last Update Date | 09/07/2017 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1427576750 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | 019027024 (Illinois) | Primary |
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