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General NPI Number Information
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NPI Number | 1669696456
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Entity Type | Organization
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Legal Business Name | MEADOW LAKE DENTAL CARE P.C.
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Dates
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Enumeration Date | 04/12/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 3941 75TH ST SUITE 102
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City | AURORA
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State | IL
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Zip | 60504-7913
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Country | US
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Telephone | 630-851-5130
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Fax |
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Provider Business Mailing Address
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Address Line | 3941 75TH ST SUITE 102
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City | AURORA
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State | IL
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Zip | 60504-7913
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Country | US
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Telephone | 630-851-5130
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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. PAUL V RICKARD
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Credential | DDS
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Telephone | 630-851-5130
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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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