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AUTUMN DENTAL OF MOKENA LLC

Dental Care Facilities

Mokena, Illinois

Provider NPI: 1427576750

Organization Information:
Organization Name:  AUTUMN DENTAL OF MOKENA LLC
Organization is not Subpart
Authorized Official:  SCOTT  BARES  OWNER  815-2752680

Practice Location:
19848 S LA GRANGE RD  MOKENA, IL 60448 US
Tel: 708-995-1859  Fax: --

Business Mailing Address:
208 N WALNUT AVE  FORRESTON, IL 61030 US
Tel: 815-938-2575  Fax: --

Entity Type: Organization

Taxonomy:

PrimaryCodeCategory/DescriptionStateLicense Number
Y261QD0000XAmbulatory Health Care Facilities
Clinic/Center
Dental
IL019027024





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