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290 Springfield Dr Suite #130 Bloomingdale IL 60108-2214 | |
| (630) 980-3880 | |
| (630) 980-4828 |
| Full Name | |
|---|---|
| Speciality | Dentist |
| Location | 290 Springfield Dr, Bloomingdale, Illinois |
| Authorized Official Name and Position | Brian T Evans (OWNER) |
| Authorized Official Contact | 6309803880 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
290 Springfield Dr Suite #130 Bloomingdale IL 60108-2214 Ph: (630) 980-3880 | 290 Springfield Dr Suite #130 Bloomingdale IL 60108-2214 Ph: (630) 980-3880 |
| NPI Number | 1285985549 |
|---|---|
| Provider Enumeration Date | 09/27/2012 |
| Last Update Date | 01/14/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1285985549 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 019020133 (Illinois) | Primary |
| 332BC3200X | Durable Medical Equipment & Medical Supplies - Customized Equipment | (* (Not Available)) | Secondary |
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