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16620 W 159th St Lockport IL 60441-8012 | |
| (815) 306-4275 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 16620 W 159th St, Lockport, Illinois |
| Authorized Official Name and Position | Kendra Walker (CREDENTIALING TEAM LEAD) |
| Authorized Official Contact | 2175408312 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
16620 W 159th St Lockport IL 60441-8012 Ph: () - | 16620 W 159th St Lockport IL 60441-8012 Ph: (815) 306-4275 |
| NPI Number | 1902269079 |
|---|---|
| Provider Enumeration Date | 04/05/2016 |
| Last Update Date | 04/05/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1902269079 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (* (Not Available)) | Primary |
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