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NPI Code Detail

MEDICARE: NORTHSHORE METROPOLITAN DENTAL ASSOCIATES, INC

MEDICARE: NORTHSHORE METROPOLITAN DENTAL ASSOCIATES, INC
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
11223G0001XGeneral Practice Dentistry019025154IL
21223G0001XGeneral Practice Dentistry019010896IL
3332B00000XDurable Medical Equipment & Medical Supplies

General Provider Information

NPI Number : 1427047349
Entity Type Code : Organization
Provider Name (Legal Business Name) : NORTHSHORE METROPOLITAN DENTAL ASSOCIATES, INC
Provider Business Mailing Address
First Line : 4709 GOLF RD
Second Line : SUITE 804
City : SKOKIE
State : IL
Zip : 60076-1231
Country : US
Telephone Number : 847-673-6770
Fax Number : 847-673-6778
Provider Business Practice Location Address
First Line : 4709 GOLF RD
Second Line : SUITE 804
City : SKOKIE
State : IL
Zip : 60076-1231
Country : US
Telephone Number : 847-673-6770
Fax Number : 847-673-6778
Authorized Official
Title or Position : PRESIDENT
Name : DR. VICTOR LAU
Credential : D.D.S.
Telephone Number : 847-673-6770
Provider Enumeration Date : 10/14/2005
Last Update Date : 10/02/2019

Similar Medicare Providers

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Practice Location Address:
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60076-1231
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1710954474 — DR. FRANK PAUL LA FRANCO MD
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1093767733 — DR. ERIN ARNOLD MD
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4709 GOLF RD , SUITE 1200
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Practice Phone: 847-869-7233
Practice Fax: 847-869-9461
1538112255 — STEVEN SCLAMBERG MD
Practice Location Address:
4709 GOLF RD , SUITE 1200
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Practice Location Address:
4709 GOLF RD , SUITE 1200
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1235179961 — EDWARD L SCLAMBERG MD
Practice Location Address:
4709 GOLF RD , SUITE 1200
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60076-1231
Practice Phone: 847-869-7233
Practice Fax: 847-869-9461

Directions to “NORTHSHORE METROPOLITAN DENTAL ASSOCIATES, INC ” Practice Location

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