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General NPI Number Information
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NPI Number | 1497820351
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Entity Type | Organization
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Legal Business Name | TOWNHALL DENTAL ASSOCIATES
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Dates
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Enumeration Date | 11/22/2006
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Last Update Date | 08/07/2008
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Provider Practice Location Address
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Address Line | 620 TOWNHALL DR
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City | ROMEOVILLE
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State | IL
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Zip | 60446
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Country | US
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Telephone | 815-886-0875
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Fax | 815-886-0075
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Provider Business Mailing Address
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Address Line | 5526 E. LAKE DR. A
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City | LISLE
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State | IL
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Zip | 60532
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Country | US
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Telephone | 630-373-6309
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Fax | 630-963-8371
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Authorized Official
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Title or Position | DENTIST
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Name | MARCUS S MERCER
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Credential | DDS
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Telephone | 815-886-0875
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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 | 019018685
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License Number State | IL
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