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General NPI Number Information
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NPI Number | 1598927733
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Entity Type | Organization
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Legal Business Name | QUINTESSENTIAL DENTAL
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Dates
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Enumeration Date | 06/30/2008
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Last Update Date | 06/30/2008
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Provider Practice Location Address
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Address Line | 132 N ADDISON AVE
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City | ELMHURST
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State | IL
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Zip | 60126-2864
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Country | US
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Telephone | 630-834-4140
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Fax | 630-834-4577
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Provider Business Mailing Address
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Address Line | 132 N ADDISON AVE
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City | ELMHURST
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State | IL
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Zip | 60126-2864
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Country | US
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Telephone | 630-834-4140
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Fax | 630-834-4577
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Authorized Official
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Title or Position | PRESIDENT/DENTIST
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Name | DR. MAGGIE W AUGUSTYN
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Credential | DDS
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Telephone | 630-834-4140
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 019025217
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 019026397
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License Number State | IL
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