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General NPI Number Information
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NPI Number | 1265978829
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Entity Type | Organization
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Legal Business Name | COMPASS DENTAL OF NORTHBROOK LLC
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Dates
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Enumeration Date | 01/06/2017
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Last Update Date | 01/06/2017
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Provider Practice Location Address
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Address Line | 1500 SHERMER RD SUITE 222E
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City | NORTHBROOK
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State | IL
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Zip | 60062-5340
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Country | US
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Telephone | 847-564-8780
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Fax |
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Provider Business Mailing Address
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Address Line | 1500 SHERMER RD SUITE 222E
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City | NORTHBROOK
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State | IL
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Zip | 60062-5340
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Country | US
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Telephone |
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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. BRANDON PRUSA
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Credential | DDS
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Telephone | 773-525-2011
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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 |
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License Number State |
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