| Madison Street Dental Llc | |
|
210 N Madison St Woodstock IL 60098-3450 | |
| (815) 338-7569 | |
| Not Available |
| Full Name | Madison Street Dental Llc |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 210 N Madison St, Woodstock, Illinois |
| Authorized Official Name and Position | Kristy Wolter (INSURANCE MANAGER) |
| Authorized Official Contact | 6303393172 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Madison Street Dental Llc 1699 E Woodfield Rd Ste 102 Schaumburg IL 60173-4955 Ph: (630) 339-3172 | Madison Street Dental Llc 210 N Madison St Woodstock IL 60098-3450 Ph: (815) 338-7569 |
| NPI Number | 1497260152 |
|---|---|
| Provider Enumeration Date | 12/04/2017 |
| Last Update Date | 12/04/2017 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1497260152 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | 019015666 (Illinois) | Primary |
| 261QD0000X | Clinic/center - Dental | 019018403 (Illinois) | Secondary |
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