| |
148 E Lake St Unit C Bloomingdale IL 60108-1182 | |
(630) 980-8800 | |
Not Available |
Full Name | |
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Speciality | Dentist - Orthodontics And Dentofacial Orthopedics |
Location | 148 E Lake St, Bloomingdale, Illinois |
Authorized Official Name and Position | Andre Jham (DDS) |
Authorized Official Contact | 6309808800 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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148 E Lake St Unit C Bloomingdale IL 60108-1182 Ph: (630) 980-8800 | 148 E Lake St Unit C Bloomingdale IL 60108-1182 Ph: (630) 980-8800 |
NPI Number | 1356683536 |
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Provider Enumeration Date | 03/26/2013 |
Last Update Date | 10/30/2013 |
Identifier | Type | State | Issuer |
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1356683536 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
1223P0221X | Dentist - Pediatric Dentistry | 019028919 (Illinois) | Secondary |
1223X0400X | Dentist - Orthodontics And Dentofacial Orthopedics | 019028920 (Illinois) | Primary |
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