MEDICARE: NEXTGEN ENDODONTICS LTD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223E0200X	Endodontics	021.002376	IL

General Provider Information

NPI Number	:	1295013290
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEXTGEN ENDODONTICS LTD

Provider Business Mailing Address
First Line	:	200 MILWAUKEE AVE
Second Line	:
City	:	BUFFALO GROVE
State	:	IL
Zip	:	60089-2812
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	200 MILWAUKEE AVE
Second Line	:
City	:	BUFFALO GROVE
State	:	IL
Zip	:	60089-2812
Country	:	US
Telephone Number	:	847-520-0770
Fax Number	:

Authorized Official
Title or Position	:	RECEPTIONIST
Name	:	NERITA STRACHAN
Credential	:
Telephone Number	:	847-520-0770

Provider Enumeration Date	:	07/26/2011
Last Update Date	:	07/26/2011

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