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General NPI Number Information
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NPI Number | 1538443890
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Entity Type | Organization
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Legal Business Name | DENTAL ART CLINIC
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Dates
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Enumeration Date | 10/05/2011
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Last Update Date | 10/05/2011
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Provider Practice Location Address
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Address Line | 1512 N ELMHURST RD
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City | MT PROSPECT
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State | IL
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Zip | 60056-1011
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Country | US
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Telephone | 847-590-5200
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Fax | 866-226-8343
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Provider Business Mailing Address
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Address Line | 1512 N ELMHURST RD
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City | MT PROSPECT
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State | IL
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Zip | 60056-1011
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Country | US
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Telephone | 847-590-5200
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Fax | 866-226-8343
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JOANNA MARIA TYLMAN
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Credential | DDS
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Telephone | 847-590-5200
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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 | 019026882
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License Number State | IL
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