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General NPI Number Information
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NPI Number | 1821245531
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Entity Type | Organization
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Legal Business Name | DENTAL CENTER
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Dates
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Enumeration Date | 08/25/2008
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Last Update Date | 08/25/2008
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Provider Practice Location Address
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Address Line | 264 HAWTHORN VILLAGE COMMONS
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City | VERNON HILLS
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State | IL
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Zip | 60061-1519
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Country | US
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Telephone | 847-367-6760
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Fax |
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Provider Business Mailing Address
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Address Line | 264 HAWTHORN VILLIAGE COMMONS
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City | VERNON HILLS
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State | IL
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Zip | 60061
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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 | DENTIST
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Name | STEVEN M HOFFENBERG
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Credential |
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Telephone | 847-367-6760
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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 | 1916309
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License Number State | IL
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