| Lisle Dental Specialists,inc | |
|
6070 State Route 53 Lisle IL 60532-3395 | |
| (630) 426-7365 | |
| (630) 963-9344 |
| Full Name | Lisle Dental Specialists,inc |
|---|---|
| Speciality | Dentist - Periodontics |
| Location | 6070 State Route 53, Lisle, Illinois |
| Authorized Official Name and Position | Douglad Chang (OWNER) |
| Authorized Official Contact | 6307477778 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Lisle Dental Specialists,inc 6070 State Route 53 Lisle IL 60532-3395 Ph: (630) 426-7365 | Lisle Dental Specialists,inc 6070 State Route 53 Lisle IL 60532-3395 Ph: (630) 426-7365 |
| NPI Number | 1801633664 |
|---|---|
| Provider Enumeration Date | 07/10/2024 |
| Last Update Date | 07/10/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1801633664 | NPI | - | NPPES |
| 1588977516 | Other | IL | ENDODONTIST |
| 1639958010 | Other | IL | PERIODONTIST |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223E0200X | Dentist - Endodontics | (* (Not Available)) | Secondary |
| 1223P0300X | Dentist - Periodontics | (* (Not Available)) | Primary |
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