| Periodontics Ltd. | |
|
111 N Wabash Ave Ste 919 Chicago IL 60602-1932 | |
| (312) 641-2572 | |
| (312) 641-6621 |
| Full Name | Periodontics Ltd. |
|---|---|
| Speciality | Dentist - Periodontics |
| Location | 111 N Wabash Ave Ste 919, Chicago, Illinois |
| Authorized Official Name and Position | Stephen P Russo (PERIODONTIST) |
| Authorized Official Contact | 3126412572 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Periodontics Ltd. 111 N Wabash Ave Ste 919 Chicago IL 60602-1932 Ph: (312) 641-2572 | Periodontics Ltd. 111 N Wabash Ave Ste 919 Chicago IL 60602-1932 Ph: (312) 641-2572 |
| NPI Number | 1336219856 |
|---|---|
| Provider Enumeration Date | 11/09/2006 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1336219856 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0300X | Dentist - Periodontics | (Illinois) | Primary |
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