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General NPI Number Information
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NPI Number | 1265707046
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Entity Type | Organization
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Legal Business Name | WEBSTER DENTAL CARE
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Dates
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Enumeration Date | 03/13/2012
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Last Update Date | 03/13/2012
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Provider Practice Location Address
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Address Line | 539 N LA GRANGE RD SUITE 1
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City | LA GRANGE PARK
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State | IL
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Zip | 60526-5647
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Country | US
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Telephone | 708-354-1070
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Fax |
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Provider Business Mailing Address
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Address Line | 539 N LA GRANGE RD SUITE 1
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City | LA GRANGE PARK
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State | IL
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Zip | 60526-5647
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Country | US
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Telephone | 708-354-1070
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. STEVE P REMPAS
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Credential | D.D.S.
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Telephone | 847-763-5890
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 019015631
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License Number State | IL
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