Dentist At Your Door Llc | |
19512 Sequoia Ave Lynwood IL 60411-6825 | |
(708) 828-8637 | |
Not Available |
Full Name | Dentist At Your Door Llc |
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Speciality | Dentist |
Location | 19512 Sequoia Ave, Lynwood, Illinois |
Authorized Official Name and Position | Shanda Lolita Bundy-smith (DENTIST) |
Authorized Official Contact | 7088288637 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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Dentist At Your Door Llc 19512 Sequoia Ave Lynwood IL 60411-6825 Ph: (708) 828-8637 | Dentist At Your Door Llc 19512 Sequoia Ave Lynwood IL 60411-6825 Ph: (708) 828-8637 |
NPI Number | 1487810685 |
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Provider Enumeration Date | 08/06/2008 |
Last Update Date | 08/06/2008 |
Identifier | Type | State | Issuer |
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1487810685 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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122300000X | Dentist | 019023785 (Illinois) | Primary |