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Contact Information

LAGRANGE PERIODONTICS, LTD
6520 JOLIET RD
COUNTRYSIDE, IL60525
 Phone: 708-354-4545
 Fax: 708-354-0336
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Periodontics

1223P0300X
Indicates primary specialty

NPI Profile & details for LAGRANGE PERIODONTICS, LTD

NPI # 1023175775
LBN Legal business name LAGRANGE PERIODONTICS, LTD
Authorized official MICHELLE JENNINGS - (PRESIDENT/PERIODONTIST)
Entity Organization
Organization subpart 1 No
Enumeration date 01/02/2007
Last updated 10/30/2019 - About 7 years ago
Identifiers
IL License # 21001423
IL License # 21001561
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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