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General NPI Number Information
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NPI Number | 1497008601
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Entity Type | Organization
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Legal Business Name | SACREY & SACREY DENTISTRY LTD
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Dates
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Enumeration Date | 10/25/2012
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Last Update Date | 10/25/2012
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Provider Practice Location Address
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Address Line | 328 ANDERSON BLVD
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City | GENEVA
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State | IL
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Zip | 60134-1206
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Country | US
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Telephone | 630-232-0659
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Fax |
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Provider Business Mailing Address
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Address Line | 328 ANDERSON BLVD
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City | GENEVA
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State | IL
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Zip | 60134-1206
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Country | US
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Telephone | 630-232-0659
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | ELIZABETH SACREY
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Credential | DDS
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Telephone | 630-232-0659
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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 | 060008026
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License Number State | IL
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