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9990 W 190th St Suite D Mokena IL 60448-8188 | |
| (708) 479-9797 | |
| (708) 478-4571 |
| Full Name | |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 9990 W 190th St, Mokena, Illinois |
| Authorized Official Name and Position | Kim Wilson (CRED SUPERIVOSR) |
| Authorized Official Contact | 2175405170 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
9990 W 190th St Suite D Mokena IL 60448-8188 Ph: (708) 479-9797 | 9990 W 190th St Suite D Mokena IL 60448-8188 Ph: (708) 479-9797 |
| NPI Number | 1043609167 |
|---|---|
| Provider Enumeration Date | 01/13/2015 |
| Last Update Date | 01/13/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1043609167 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (* (Not Available)) | Primary |
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