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General NPI Number Information
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NPI Number | 1841482486
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Entity Type | Organization
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Legal Business Name | GARLAND DENTAL ASSOCIATES, LTD.
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Dates
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Enumeration Date | 08/17/2007
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Last Update Date | 01/12/2017
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Provider Practice Location Address
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Address Line | 30 N. MICHIGAN AVE SUITE 1803
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City | CHICAGO
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State | IL
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Zip | 60602
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Country | US
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Telephone | 872-256-5003
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Fax | 773-282-4962
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Provider Business Mailing Address
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Address Line | 30 N. MICHIGAN AVE. SUITE 1803
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City | CHICAGO
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State | IL
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Zip | 60602
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Country | US
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Telephone | 872-256-5003
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Fax | 773-282-4962
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. THOMAS JAMES MCDERMOTT
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Credential | D.D.S
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Telephone | 872-256-5003
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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 | 060004452
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License Number State | IL
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