MEDICARE: MARENGO DENTAL

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	1223G0001X	General Practice Dentistry	019-020199	IL

General Provider Information

NPI Number	:	1760608731
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARENGO DENTAL

Provider Business Mailing Address
First Line	:	110 E WASHINGTON ST
Second Line	:
City	:	MARENGO
State	:	IL
Zip	:	60152-3107
Country	:	US
Telephone Number	:	815-568-1202
Fax Number	:

Provider Business Practice Location Address
First Line	:	110 E WASHINGTON ST
Second Line	:
City	:	MARENGO
State	:	IL
Zip	:	60152-3107
Country	:	US
Telephone Number	:	815-568-1202
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. GARY DETTMAN
Credential	:
Telephone Number	:	815-568-1202

Provider Enumeration Date	:	04/18/2007
Last Update Date	:	09/09/2008

Similar Medicare Providers

1851470470 — DR. GARY R DETTMAN DDS
Practice Location Address:

110 E WASHINGTON ST
MARENGO, IL
60152-3107

Practice Phone: 815-568-1202
Practice Fax:

1053447458 — DR. MARTHA K BASILE DDS
Practice Location Address:

110 E WASHINGTON ST
MARENGO, IL
60152-3107

Practice Phone: 815-568-1202
Practice Fax:

1366769218 — SWEDISHAMERICAN HOSPITAL
Practice Location Address:

204 E PRAIRIE ST
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Practice Fax:

1205154440 — SWEDISHAMERICAN HOSPITAL
Practice Location Address:

204 E PRAIRIE ST
MARENGO, IL
60152-3107

Practice Phone: 779-696-9553
Practice Fax:

1265245013 — RACHEL NAROFSKY RDN, LDN
Practice Location Address:

204 E PRAIRIE ST APT 7
MARENGO, IL
60152-3107

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Practice Fax:

1831529023 — TOTAL RENAL CARE INC
Practice Location Address:

910 GREENLEE ST UNIT B
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60152-8200

Practice Phone: 815-568-5800
Practice Fax: 815-568-5900

Directions to “MARENGO DENTAL ” Practice Location

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