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General NPI Number Information
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NPI Number | 1639733488
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Entity Type | Organization
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Legal Business Name | CAMBRIDGE DENTAL CARE LTD
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Dates
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Enumeration Date | 04/26/2019
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Last Update Date | 04/26/2019
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Provider Practice Location Address
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Address Line | 17853 80TH AVE
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City | TINLEY PARK
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State | IL
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Zip | 60477-5023
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Country | US
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Telephone | 708-429-9900
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Fax | 708-429-4416
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Provider Business Mailing Address
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Address Line | 17853 80TH AVE
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City | TINLEY PARK
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State | IL
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Zip | 60477-5023
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Country | US
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Telephone | 708-429-9900
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Fax | 708-429-4416
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Authorized Official
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Title or Position | OWNER DENTIST
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Name | DR. EDMOND J HANLEY
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Credential |
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Telephone | 708-429-9900
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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 |
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License Number State |
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