Healthcare Provider Details

I. General information

NPI: 1184799611
Provider Name (Legal Business Name): DBM DENTAL LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21136 WASHINGTON PKWY
FRANKFORT IL
60423-3112
US

IV. Provider business mailing address

21136 WASHINGTON PKWY
FRANKFORT IL
60423-3112
US

V. Phone/Fax

Practice location:
  • Phone: 815-469-6767
  • Fax: 815-469-7641
Mailing address:
  • Phone: 815-469-6767
  • Fax: 815-469-7641

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number StateIL

VIII. Authorized Official

Name: DR. MICHAEL PERRY
Title or Position: DIRECT OWNER
Credential: D.D.S.
Phone: 815-469-6767