| Nelson Ridge Family Dental | |
|
820 Laraway Rd New Lenox IL 60451-2694 | |
| (815) 524-6000 | |
| Not Available |
| Full Name | Nelson Ridge Family Dental |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 820 Laraway Rd, New Lenox, Illinois |
| Authorized Official Name and Position | Paul E Etchison (OWNER) |
| Authorized Official Contact | 8155246000 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Nelson Ridge Family Dental 820 Laraway Rd New Lenox IL 60451-2694 Ph: () - | Nelson Ridge Family Dental 820 Laraway Rd New Lenox IL 60451-2694 Ph: (815) 524-6000 |
| NPI Number | 1306111349 |
|---|---|
| Provider Enumeration Date | 03/08/2012 |
| Last Update Date | 03/08/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1306111349 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | 019.027903 (Illinois) | Primary |
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