| Great Lakes Dental Solutions | |
|
1418 S Milwaukee Ave Suite 4 Libertyville IL 60048-3796 | |
| (815) 209-6272 | |
| Not Available |
| Full Name | Great Lakes Dental Solutions |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 1418 S Milwaukee Ave, Libertyville, Illinois |
| Authorized Official Name and Position | Anshuman Soni (PRESIDENT / DENTIST) |
| Authorized Official Contact | 8152096272 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Great Lakes Dental Solutions 1418 S Milwaukee Ave Suite 4 Libertyville IL 60048-3796 Ph: () - | Great Lakes Dental Solutions 1418 S Milwaukee Ave Suite 4 Libertyville IL 60048-3796 Ph: (815) 209-6272 |
| NPI Number | 1447657234 |
|---|---|
| Provider Enumeration Date | 11/23/2014 |
| Last Update Date | 12/16/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1447657234 | NPI | - | NPPES |
| 1265415244 | Other | IL | NPI 1 |
| 9176879 | Medicaid | IL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | 019026289 (Illinois) | Primary |
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