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DR. ALBERT A. DIEPSTRA D.D.S.

General Practice >> Dentist >> Dental Providers

Registrant NPI Number: 1356518179

Individual Registrant:
DR. ALBERT A. DIEPSTRA D.D.S.
Gender: M
Not Sole Proprietor

Location and contact information for practice:
342 SHERWOOD RD  LA GRANGE PARK, IL 60526-1967 US
Tel: 708-482-4610  Fax: --

Contact information for business:
342 SHERWOOD RD  LA GRANGE PARK, IL 60526-1967 US
Tel: 708-482-4610  Fax: --

Registration Information:
NPI: 1356518179
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
Y1223G0001XDental Providers
Dentist
General Practice
IL19A15115

Legacy codes, insurance codes and state license numbers:

IssuerNumberStateType




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