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Great Lakes Dental P.c.
Dental Clinic/Center in Libertyville, Illinois
NPI 1447657234

Great Lakes Dental P.c. is a Dental Clinic/Center based in Libertyville, IL and is specialized in Dental. Great Lakes Dental P.c. practices in Libertyville, IL. The NPI Number for Great Lakes Dental P.c. is 1447657234 and holds a License No. 019026289 (Illinois).

The current practice location address for Great Lakes Dental P.c. is 1418 S Milwaukee Ave, Libertyville, IL and can be reached out via phone at 815-209-6272.

Location: 1418 S Milwaukee Ave, Libertyville, IL, 60048-3796
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
institution
Provider Profile Details
NPI Number
1447657234
Provider Name
Great Lakes Dental P.c.
Credential
Provider Entity Type
Organization
Address
1418 S Milwaukee Ave, Libertyville, IL, 60048-3796
Phone Number
815-209-6272
Fax Number
Provider Enumeration Date
11/23/2014
Last Update Date
03/09/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
1265415244 01 IL NPI 1
9176879 05 IL
institution
Provider Business Practice Location Address Details
Address
1418 S Milwaukee Ave
City
Libertyville
State
Illinois
Zip
60048-3796
Phone Number
815-209-6272
Fax Number
person
Provider Business Mailing Address Details
Address
1418 S Milwaukee Ave
City
Libertyville
State
Illinois
Zip
60048-3796
Phone Number
815-209-6272
Fax Number
person
Provider's Taxonomy Details 1
Type
Ambulatory Health Care Facilities
Classification
Clinic/Center
Speciality
Dental
Taxonomy
261QD0000X
License No.
019026289 (Illinois)
Definition
Definition to come...
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