| Lavergne Dental Care Pc | |
|
4939 W 14th St Cicero IL 60804-1419 | |
| (708) 652-1080 | |
| (708) 652-3080 |
| Full Name | Lavergne Dental Care Pc |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 4939 W 14th St, Cicero, Illinois |
| Authorized Official Name and Position | Sherin B Jacob (PRESIDENT) |
| Authorized Official Contact | 7086521080 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Lavergne Dental Care Pc 4939 W 14th St Cicero IL 60804-1419 Ph: (708) 652-1080 | Lavergne Dental Care Pc 4939 W 14th St Cicero IL 60804-1419 Ph: (708) 652-1080 |
| NPI Number | 1245415256 |
|---|---|
| Provider Enumeration Date | 01/09/2008 |
| Last Update Date | 01/09/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1245415256 | NPI | - | NPPES |
| 179906 | Medicaid | IL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (Illinois) | Primary |
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