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General NPI Number Information
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NPI Number | 1124573639
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Entity Type | Organization
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Legal Business Name | BORDIGNON DENTAL ASSOCIATES
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Dates
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Enumeration Date | 08/25/2016
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Last Update Date | 08/25/2016
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Provider Practice Location Address
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Address Line | 1730 DEWES ST
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City | GLENVIEW
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State | IL
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Zip | 60025-4316
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Country | US
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Telephone | 847-724-2160
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Fax | 847-729-8814
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Provider Business Mailing Address
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Address Line | 1730 DEWES ST
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City | GLENVIEW
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State | IL
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Zip | 60025-4316
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Country | US
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Telephone | 847-724-2160
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Fax | 847-729-8814
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Authorized Official
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Title or Position | GENERAL DENTIST
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Name | DR. THOMAS V BORDIGNON
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Credential | DDS
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Telephone | 847-724-2160
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 019-02251
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License Number State | IL
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