HPOMS

NPI # 

Practice Address:

1893 Sheridan Rd Suite 311

Highland Park, IL, 60035

Practice Phone:

847-433-6636

Practice Fax:

847-433-2090

License Number:

019.022948

License State:

IL

Taxonomy Grouping:

Ambulatory Health Care Facilities

Taxonomy Classification:

Clinic/Center

Taxonomy Specialization:

Dental

Taxonomy Code:

261QD0000X