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General NPI Number Information
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NPI Number | 1306853429
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Entity Type | Organization
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Legal Business Name | WINTHROP HARBOR DENTAL CENTER
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Dates
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Enumeration Date | 08/02/2006
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Last Update Date | 11/28/2011
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Provider Practice Location Address
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Address Line | 644 SHERIDAN RD SUITE 105
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City | WINTHROP HARBOR
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State | IL
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Zip | 60096-1350
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Country | US
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Telephone | 847-872-5626
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Fax | 847-746-2900
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Provider Business Mailing Address
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Address Line | 644 SHERIDAN RD SUITE 105
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City | WINTHROP HARBOR
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State | IL
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Zip | 60096-1350
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Country | US
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Telephone | 847-872-5626
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Fax | 847-746-2900
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Authorized Official
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Title or Position | BUSINESS MANAGER
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Name | MRS. MICHELLE L OPELT
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Credential |
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Telephone | 847-872-5626
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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 | 019015026
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License Number State | IL
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