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General NPI Number Information
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NPI Number | 1487154886
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Entity Type | Organization
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Legal Business Name | DAVID S. CENTER DDS LTD
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Dates
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Enumeration Date | 02/13/2018
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Last Update Date | 02/13/2018
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Provider Practice Location Address
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Address Line | 9933 LAWLER AVE STE 204
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City | SKOKIE
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State | IL
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Zip | 60077-3757
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Country | US
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Telephone | 847-677-0080
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Fax | 847-677-0097
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Provider Business Mailing Address
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Address Line | 9933 LAWLER AVE STE 204
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City | SKOKIE
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State | IL
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Zip | 60077-3757
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Country | US
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Telephone | 847-677-0080
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Fax | 847-677-0097
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | IVY LYNNE TUBER
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Credential |
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Telephone | 847-677-0080
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 019.016609
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License Number State | IL
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