Green Bay Trail Dentistry

NPI 1457405987 - Dentist - 122300000X

NPI Details
NPI 1457405987
Enumeration Date 01/22/2007
Last Updated 05/24/2011
Entity Type Healthcare Provider
Active Over 9 years ago
Authorized Information
Name ERIC ERIC
Position OWNER PROVIDER
Phone (847) 869-4844
Fax
Practice Location
2632 GREEN BAY RD
EVANSTON IL, 60201, US
Phone (847) 869-4844
Fax
Business Location
2632 GREEN BAY RD
EVANSTON IL, 60201, US
Phone (847) 869-4844
Fax
Toxanomy
Taxonomy Code 122300000X
License State Illinois
License Number 019021406
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According to our database, Green Bay Trail Dentistry NPI is 1457405987, taxonomy code is 122300000X and license number is 019021406, license state is located at Illinois. Green Bay Trail Dentistry physically located at 2632 Green Bay Rd, Evanston IL, 60201. NPI Number 1033115704 has the healthcare provider type.

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1457405987 NPI number is provided on an as is basis without warranty of any kind. 1457405987 is maintained by the National Plan & Provider Enumeration System. The contents of Green Bay Trail Dentistry are for informational purposes only.