| Lake Forest Pediatic Dentistry, Pc | |
|
500 N Western Ave Suite 215 Lake Forest IL 60045-1954 | |
| (847) 482-1900 | |
| Not Available |
| Full Name | Lake Forest Pediatic Dentistry, Pc |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 500 N Western Ave, Lake Forest, Illinois |
| Authorized Official Name and Position | Joseph Gordon (PEDIATRIC DENTIST, PRESIDENT) |
| Authorized Official Contact | 8474821900 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Lake Forest Pediatic Dentistry, Pc 500 N Western Ave Suite 215 Lake Forest IL 60045-1954 Ph: () - | Lake Forest Pediatic Dentistry, Pc 500 N Western Ave Suite 215 Lake Forest IL 60045-1954 Ph: (847) 482-1900 |
| NPI Number | 1841608502 |
|---|---|
| Provider Enumeration Date | 07/25/2014 |
| Last Update Date | 07/25/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1841608502 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | 019024258 (Illinois) | Primary |
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