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General NPI Number Information
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NPI Number | 1548496219
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Entity Type | Organization
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Legal Business Name | GEORGE J FUTRIS DDS LTD
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Dates
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Enumeration Date | 06/08/2009
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Last Update Date | 06/08/2009
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Provider Practice Location Address
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Address Line | 1600 W DEMPSTER ST STE 202
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City | PARK RIDGE
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State | IL
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Zip | 60068-1172
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Country | US
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Telephone | 847-699-1073
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Fax | 847-699-1134
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Provider Business Mailing Address
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Address Line | 1600 W DEMPSTER ST STE 202
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City | PARK RIDGE
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State | IL
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Zip | 60068-1172
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Country | US
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Telephone | 847-699-1073
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Fax | 847-699-1134
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Authorized Official
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Title or Position | SECRETARY
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Name | MRS. ANNA FUTRIS
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Credential |
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Telephone | 847-699-1073
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3140N1450X
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Taxonomy Name | Pediatric Skilled Nursing Facility
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License Number | 019-014469
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License Number State | IL
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