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26 N Park Blvd Glen Ellyn IL 60137-5712 | |
| (630) 858-8800 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 26 N Park Blvd, Glen Ellyn, Illinois |
| Authorized Official Name and Position | Jessica Lynn Gibbs (DENTIST/OWNER) |
| Authorized Official Contact | 6304521281 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
26 N Park Blvd Glen Ellyn IL 60137-5712 Ph: (630) 858-8800 | 26 N Park Blvd Glen Ellyn IL 60137-5712 Ph: (630) 858-8800 |
| NPI Number | 1780492959 |
|---|---|
| Provider Enumeration Date | 12/20/2024 |
| Last Update Date | 12/31/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1780492959 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | (* (Not Available)) | Primary |
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