| Douglas Dental Center | |
|
2605a Grand Ave Waukegan IL 60085-2410 | |
| (847) 244-7779 | |
| Not Available |
| Full Name | Douglas Dental Center |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 2605a Grand Ave, Waukegan, Illinois |
| Authorized Official Name and Position | Ajitha Paruchuri (PRESIDENT) |
| Authorized Official Contact | 6302295469 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Douglas Dental Center 2605a Grand Ave Waukegan IL 60085-2410 Ph: (847) 244-7779 | Douglas Dental Center 2605a Grand Ave Waukegan IL 60085-2410 Ph: (847) 244-7779 |
| NPI Number | 1013120005 |
|---|---|
| Provider Enumeration Date | 05/07/2007 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1013120005 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (Illinois) | Primary |
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