| Full Name | |
|---|---|
| Speciality | Dentist |
| Location | 1030 Summit St, Elgin, Illinois |
| Authorized Official Name and Position | Stephanie Moore (DIRECTOR OF REVENUE CYCLE) |
| Authorized Official Contact | 8327044262 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
Po Box 8248 Carol Stream IL 60197-8248 Ph: (847) 888-8282 | 1030 Summit St Elgin IL 60120-4371 Ph: (847) 888-8282 |
| NPI Number | 1376214346 |
|---|---|
| Provider Enumeration Date | 09/21/2021 |
| Last Update Date | 07/26/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1376214346 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | (* (Not Available)) | Primary |
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