| Dental Associates Of South Ridge, P.c. | |
|
6121 Washington St #202 Gurnee IL 60031-5305 | |
| (847) 625-9897 | |
| Not Available |
| Full Name | Dental Associates Of South Ridge, P.c. |
|---|---|
| Speciality | Dentist |
| Location | 6121 Washington St, Gurnee, Illinois |
| Authorized Official Name and Position | Priyadarshini Boinpally (PRESIDENT) |
| Authorized Official Contact | 8476259897 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Dental Associates Of South Ridge, P.c. 483 Evergreen Dr Vernon Hills IL 60061-2907 Ph: (847) 625-9897 | Dental Associates Of South Ridge, P.c. 6121 Washington St #202 Gurnee IL 60031-5305 Ph: (847) 625-9897 |
| NPI Number | 1396292884 |
|---|---|
| Provider Enumeration Date | 09/01/2016 |
| Last Update Date | 09/01/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1396292884 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 019028057 (Illinois) | Primary |
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