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General NPI Number Information
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NPI Number | 1992858674
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Entity Type | Organization
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Legal Business Name | 176 DENTAL ASSOCIATES LTD
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Dates
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Enumeration Date | 01/18/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 176 S BLOOMINGDALE RD
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City | BLOOMINGDALE
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State | IL
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Zip | 60108-1404
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Country | US
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Telephone | 630-893-6200
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Fax | 630-893-0474
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Provider Business Mailing Address
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Address Line | 176 S BLOOMINGDALE RD
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City | BLOOMINGDALE
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State | IL
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Zip | 60108-1404
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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 | OWNER
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Name | JOSEPH MATUSTIK
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Credential |
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Telephone | 630-893-6200
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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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