| Lagrange Dental Management | |
|
342 Sherwood Rd La Grange Park IL 60526-1967 | |
| (708) 482-4610 | |
| (708) 482-0246 |
| Full Name | Lagrange Dental Management |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 342 Sherwood Rd, La Grange Park, Illinois |
| Authorized Official Name and Position | Jonathan Villanueva (PRACTICE MANAGER) |
| Authorized Official Contact | 6303246749 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Lagrange Dental Management 342 Sherwood Rd La Grange Park IL 60526-1967 Ph: (708) 482-4610 | Lagrange Dental Management 342 Sherwood Rd La Grange Park IL 60526-1967 Ph: (708) 482-4610 |
| NPI Number | 1013151901 |
|---|---|
| Provider Enumeration Date | 04/23/2009 |
| Last Update Date | 04/23/2009 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1013151901 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 019022779 (Illinois) | Primary |
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