| Dental Profile 2 | |
|
120 E Lake St Addison IL 60101-2821 | |
| (630) 530-2498 | |
| (630) 530-2689 |
| Full Name | Dental Profile 2 |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 120 E Lake St, Addison, Illinois |
| Authorized Official Name and Position | Milan Roncevic (GENERAL MANAGER) |
| Authorized Official Contact | 6305160000 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Dental Profile 2 120 E Lake St Addison IL 60101-2821 Ph: (630) 530-2498 | Dental Profile 2 120 E Lake St Addison IL 60101-2821 Ph: (630) 530-2498 |
| NPI Number | 1477724870 |
|---|---|
| Provider Enumeration Date | 03/13/2008 |
| Last Update Date | 03/13/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1477724870 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (Illinois) | Primary |
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