| NPI | 1811036718 |
|---|---|
| Former Legal Business Name | PERIODONTAL MEDICINE AND SURGICAL SPECIALISTS, LTD |
| Entity Type | Organization |
| Authorized Contact | GEORGE A MANDELARIS Owner Periodontist 630-627-3930 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: IL 060-003629) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: IL 019030200) |
| 1223P0300X Dentist, Periodontics (Licence: IL 019024971) | |
| 1223P0300X Dentist, Periodontics (Licence: IL 019014972) | |
| Enumeration Date | 2007-02-06 |
| Last Update Date | 2016-12-16 |