| Stratford Square Periodontics | |
|
1 Tiffany Pt Ste 205 Bloomingdale IL 60108-2916 | |
| (630) 582-3120 | |
| (630) 582-3137 |
| Full Name | Stratford Square Periodontics |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 1 Tiffany Pt Ste 205, Bloomingdale, Illinois |
| Authorized Official Name and Position | Juzer Chinwalla (PRESIDENT) |
| Authorized Official Contact | 6305823120 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Stratford Square Periodontics 1 Tiffany Pt Ste 205 Bloomingdale IL 60108-2916 Ph: (630) 582-3120 | Stratford Square Periodontics 1 Tiffany Pt Ste 205 Bloomingdale IL 60108-2916 Ph: (630) 582-3120 |
| NPI Number | 1821376260 |
|---|---|
| Provider Enumeration Date | 08/03/2011 |
| Last Update Date | 08/03/2011 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1821376260 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | 019023850 (Illinois) | Primary |
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