| 162nd Street Dental | |
|
1022 E 162nd St South Holland IL 60473-2560 | |
| (312) 493-6089 | |
| Not Available |
| Full Name | 162nd Street Dental |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 1022 E 162nd St, South Holland, Illinois |
| Authorized Official Name and Position | Samuel Osobu (PRESIDENT) |
| Authorized Official Contact | 3124936089 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| 162nd Street Dental 2120 W Washington Blvd Suite. 306 Chicago IL 60612-2346 Ph: (312) 493-6089 | 162nd Street Dental 1022 E 162nd St South Holland IL 60473-2560 Ph: (312) 493-6089 |
| NPI Number | 1366975419 |
|---|---|
| Provider Enumeration Date | 04/06/2017 |
| Last Update Date | 04/06/2017 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1366975419 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | 019030498 (Illinois) | Primary |
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