Organization Name: | THTACHER WOODS ASSOCIATES LTD |
NPI Number: | 1811150410 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | GREGORY A. BERTAGNA (PARTNER) |
Mailing Address: | 8383 W Belmont Ave Suite 200 River Grove |
State: | IL US |
Postal Code: | 60171 |
Phone Number: | 7084531110 |
Fax Number: | 7084520157 |
NPI Enumeration Date: | 07/03/2008 |
NPI Last Update Date: | 07/03/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QD0000X |
License Number: | 019.017754 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IL |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Dental |
Taxonomy Definition: |