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General NPI Number Information
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NPI Number | 1326062951
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Entity Type | Organization
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Legal Business Name | PERIODONITCS OF ELGIN, LTD
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Dates
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Enumeration Date | 07/27/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2000 LARKIN AVE STE 306
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City | ELGIN
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State | IL
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Zip | 60123-5880
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Country | US
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Telephone | 847-697-4646
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Fax | 847-697-8364
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Provider Business Mailing Address
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Address Line | 2000 LARKIN AVE STE 306
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City | ELGIN
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State | IL
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Zip | 60123-5880
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Country | US
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Telephone | 847-697-4646
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Fax | 847-697-8364
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. FRANK A MAGGIO
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Credential | DDS
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Telephone | 847-697-4646
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 21000876
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License Number State | IL
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