| |
7235 Madison St Forest Park IL 60130-1764 | |
(708) 405-9344 | |
(216) 584-1016 |
Full Name | |
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Speciality | Dentist |
Location | 7235 Madison St, Forest Park, Illinois |
Authorized Official Name and Position | Rachel Nittinger (MANAGER CREDENTIALING) |
Authorized Official Contact | 9727550816 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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7160 Dallas Pkwy Ste 400 Plano TX 75024-7111 Ph: (972) 755-0816 | 7235 Madison St Forest Park IL 60130-1764 Ph: (708) 405-9344 |
NPI Number | 1013980705 |
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Provider Enumeration Date | 02/11/2006 |
Last Update Date | 02/08/2018 |
Identifier | Type | State | Issuer |
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1013980705 | NPI | - | NPPES |
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