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4909 Forest Ave Downers Grove IL 60515-3509 | |
| (630) 541-3696 | |
| (630) 541-9179 |
| Full Name | |
|---|---|
| Speciality | Dentist - Orthodontics And Dentofacial Orthopedics |
| Location | 4909 Forest Ave, Downers Grove, Illinois |
| Authorized Official Name and Position | Zachary T Frazier (PRESIDENT) |
| Authorized Official Contact | 6305413696 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
4909 Forest Ave Downers Grove IL 60515-3509 Ph: (630) 541-3696 | 4909 Forest Ave Downers Grove IL 60515-3509 Ph: (630) 541-3696 |
| NPI Number | 1982083135 |
|---|---|
| Provider Enumeration Date | 05/20/2015 |
| Last Update Date | 05/20/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1982083135 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223X0400X | Dentist - Orthodontics And Dentofacial Orthopedics | 019028645 (Illinois) | Primary |
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