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General NPI Number Information
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NPI Number | 1700938412
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Entity Type | Organization
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Legal Business Name | HAMILTON LAKES DENTISTRY
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Dates
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Enumeration Date | 01/16/2007
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 500 PARK BLVD SUITE 180C
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City | ITASCA
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State | IL
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Zip | 60143
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Country | US
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Telephone | 630-773-6966
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Fax | 630-773-6971
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Provider Business Mailing Address
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Address Line | 500 PARK BLVD SUITE 180C
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City | ITASCA
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State | IL
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Zip | 60143
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Country | US
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Telephone | 630-773-6966
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Fax | 630-773-6971
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MADGE PIERCE
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Credential |
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Telephone | 630-773-6966
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | TIN
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License Number State | IL
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