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General NPI Number Information
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NPI Number | 1588825954
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Entity Type | Organization
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Legal Business Name | WILMETTE DENTAL, LTD.
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Dates
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Enumeration Date | 06/19/2008
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Last Update Date | 06/19/2008
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Provider Practice Location Address
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Address Line | 344 LINDEN AVE
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City | WILMETTE
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State | IL
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Zip | 60091-2843
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Country | US
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Telephone | 847-251-0085
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Fax |
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Provider Business Mailing Address
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Address Line | 344 LINDEN AVE
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City | WILMETTE
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State | IL
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Zip | 60091-2843
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Country | US
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Telephone |
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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. PETER NEUHAUS
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Credential | DDS
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Telephone | 847-241-0085
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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 | 019-020088
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License Number State | IL
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