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General NPI Number Information
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NPI Number | 1548712532
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Entity Type | Organization
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Legal Business Name | ADVANCED FAMILY DENTAL OF LOMBARD
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Dates
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Enumeration Date | 10/26/2016
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Last Update Date | 10/26/2016
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Provider Practice Location Address
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Address Line | 1N121 COUNTY FARM RD
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City | WINFIELD
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State | IL
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Zip | 60190-2019
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Country | US
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Telephone | 815-771-1700
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Fax | 815-483-2298
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Provider Business Mailing Address
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Address Line | 1N121 COUNTY FARM RD
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City | WINFIELD
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State | IL
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Zip | 60190-2019
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Country | US
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Telephone | 815-771-1700
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Fax | 815-483-2298
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Authorized Official
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Title or Position | REGIONAL MANAGER
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Name | KATIE HOWARD
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Credential |
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Telephone | 815-741-1700
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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 |
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License Number State |
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