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General NPI Number Information
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NPI Number | 1457374415
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Entity Type | Organization
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Legal Business Name | GEORGE F DEIHS III DDS PC
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Dates
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Enumeration Date | 07/25/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 602 W MAIN ST
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City | WEST DUNDEE
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State | IL
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Zip | 60118-2026
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Country | US
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Telephone | 847-426-5030
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Fax | 847-426-1554
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Provider Business Mailing Address
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Address Line | 602 W MAIN ST
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City | WEST DUNDEE
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State | IL
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Zip | 60118-2026
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Country | US
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Telephone | 847-426-5030
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Fax | 847-426-1554
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Authorized Official
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Title or Position | OWNER
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Name | DR. GEORGE F DEIHS III
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Credential | DDS
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Telephone | 847-426-5030
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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 | 019-18876
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License Number State | IL
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