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General NPI Number Information
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NPI Number | 1538479456
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Entity Type | Organization
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Legal Business Name | PRECISION ENDODONTICS, P.C.
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Dates
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Enumeration Date | 10/13/2010
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Last Update Date | 10/13/2010
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Provider Practice Location Address
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Address Line | 215 REMINGTON BLVD
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City | BOLINGBROOK
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State | IL
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Zip | 60440-3656
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Country | US
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Telephone | 630-469-4500
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Fax |
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Provider Business Mailing Address
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Address Line | 215 REMINGTON BLVD
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City | BOLINGBROOK
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State | IL
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Zip | 60440-3656
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Country | US
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Telephone | 630-469-4500
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. FERNANDO REY URZUA
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Credential | D.D.S.
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Telephone | 630-469-4500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number | 021002327
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 305R00000X
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Taxonomy Name | Preferred Provider Organization
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License Number | 021002327
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License Number State | IL
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