| George D Di Tola Dds Ltd | |
|
3521 W Lake St Melrose Park IL 60160-2825 | |
| (708) 865-1214 | |
| (708) 865-7933 |
| Full Name | George D Di Tola Dds Ltd |
|---|---|
| Speciality | Dentist |
| Location | 3521 W Lake St, Melrose Park, Illinois |
| Authorized Official Name and Position | George Dominick Ditola (BUSINESS OWNER) |
| Authorized Official Contact | 7088651214 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| George D Di Tola Dds Ltd 3521 W Lake St Melrose Park IL 60160-2825 Ph: (708) 865-1214 | George D Di Tola Dds Ltd 3521 W Lake St Melrose Park IL 60160-2825 Ph: (708) 865-1214 |
| NPI Number | 1598746364 |
|---|---|
| Provider Enumeration Date | 11/09/2005 |
| Last Update Date | 06/16/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1598746364 | NPI | - | NPPES |
| 1001668 | Medicaid | IL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 019016202G (Illinois) | Primary |
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