Organization Name: | ASSOCIATED DENTAL SPECIALISTS OF LONG GROVE LTD |
NPI Number: | 1033383567 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | MARK L CANNON (PRESIDENT) |
Mailing Address: | Rfd 4160 Grove Medical Center Suite 308 Long Grove |
State: | IL US |
Postal Code: | 600479586 |
Phone Number: | 8476346166 |
Fax Number: | 8466346302 |
NPI Enumeration Date: | 04/16/2008 |
NPI Last Update Date: | 04/16/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 1223P0221X |
License Number: | 060.003411019.021533 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IL |
Taxonomy Type: | Dental Providers |
Taxonomy Classification: | Dentist |
Taxonomy Specialization: | Pediatric Dentistry |
Taxonomy Definition: | An age-defined specialty that provides both primary and comprehensive preventive and therapeutic oral health care for infants and children through adolescence, including those with special health care needs. |