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General NPI Number Information
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NPI Number | 1588367817
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Entity Type | Organization
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Legal Business Name | BARTLETT IMPLANTS AND DENTURES LLC
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Dates
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Enumeration Date | 03/24/2023
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Last Update Date | 03/24/2023
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Provider Practice Location Address
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Address Line | 981 ILLINOIS RTE 59
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City | BARTLETT
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State | IL
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Zip | 60103
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Country | US
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Telephone | 630-289-5522
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Fax |
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Provider Business Mailing Address
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Address Line | 300 E NORTHWEST HWY
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City | ARLINGTON HEIGHTS
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State | IL
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Zip | 60004-6126
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Country | US
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Telephone | 847-398-0811
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Fax |
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Authorized Official
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Title or Position | SOLE MEMBER
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Name | DR. JOSEPH FAVIA
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Credential | DDS
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Telephone | 630-289-5522
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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