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3419 Orchard Rd Oswego IL 60543-5005 | |
| (331) 717-0251 | |
| (331) 999-3073 |
| Full Name | |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 3419 Orchard Rd, Oswego, Illinois |
| Authorized Official Name and Position | Jessica Britt (CREDENTIALING COORDINATOR) |
| Authorized Official Contact | 2175405100 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
3419 Orchard Rd Oswego IL 60543-5005 Ph: (331) 717-0251 | 3419 Orchard Rd Oswego IL 60543-5005 Ph: (331) 717-0251 |
| NPI Number | 1669092177 |
|---|---|
| Provider Enumeration Date | 04/24/2020 |
| Last Update Date | 01/15/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1669092177 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (* (Not Available)) | Primary |
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