| Bridgeport Dental Specialists Llc | |
|
2959 S Wallace St Chicago IL 60616-3034 | |
| (312) 791-0920 | |
| (312) 842-5338 |
| Full Name | Bridgeport Dental Specialists Llc |
|---|---|
| Speciality | Dentist - Orthodontics And Dentofacial Orthopedics |
| Location | 2959 S Wallace St, Chicago, Illinois |
| Authorized Official Name and Position | Steven Vongluekiat (OWNER) |
| Authorized Official Contact | 3127910920 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Bridgeport Dental Specialists Llc 2959 S Wallace St Chicago IL 60616-3034 Ph: (312) 791-0920 | Bridgeport Dental Specialists Llc 2959 S Wallace St Chicago IL 60616-3034 Ph: (312) 791-0920 |
| NPI Number | 1932416898 |
|---|---|
| Provider Enumeration Date | 09/13/2010 |
| Last Update Date | 09/13/2010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1932416898 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223X0400X | Dentist - Orthodontics And Dentofacial Orthopedics | 019027652 (Illinois) | Primary |
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