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General NPI Number Information
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NPI Number | 1356411136
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Entity Type | Organization
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Legal Business Name | WESTCHESTER FAMILY DENTAL LTD
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Dates
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Enumeration Date | 11/08/2006
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Last Update Date | 07/24/2018
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Provider Practice Location Address
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Address Line | 4 WESTBROOK CORPORATE CENTER STE 102
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City | WESTCHESTER
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State | IL
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Zip | 60104
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Country | US
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Telephone | 708-562-5621
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Fax | 708-562-7657
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Provider Business Mailing Address
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Address Line | 4 WESTBROOK CORPORATE CENTER STE 102
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City | WESTCHESTER
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State | IL
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Zip | 60104
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Country | US
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Telephone | 708-562-5621
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Fax | 708-562-7657
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. RAFFAELE C AMBROSINO
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Credential | D.D.S.
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Telephone | 708-562-5621
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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 | 019-025052
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License Number State | IL
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