| Eco Friendly Dentistry Pc | |
|
4934 W 95th St Oak Lawn IL 60453-2504 | |
| (773) 429-1400 | |
| Not Available |
| Full Name | Eco Friendly Dentistry Pc |
|---|---|
| Speciality | Dentist |
| Location | 4934 W 95th St, Oak Lawn, Illinois |
| Authorized Official Name and Position | Gloria Chavez (ACCESS MANAGER) |
| Authorized Official Contact | 7734291400 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Eco Friendly Dentistry Pc 4934 W 95th St Oak Lawn IL 60453-2504 Ph: (773) 429-1400 | Eco Friendly Dentistry Pc 4934 W 95th St Oak Lawn IL 60453-2504 Ph: (773) 429-1400 |
| NPI Number | 1740522200 |
|---|---|
| Provider Enumeration Date | 03/22/2013 |
| Last Update Date | 07/16/2021 |
| Medicare PECOS PAC ID | 2567868227 |
|---|---|
| Medicare Enrollment ID | O20210903000090 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1740522200 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 319027955 (Illinois) | Primary |
| Provider Name | Ahmed Rasmi Mataria |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1255567483 PECOS PAC ID: 1759685746 Enrollment ID: I20200429000729 |
| Provider Name | Angela Y Suh |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1407378201 PECOS PAC ID: 4880075852 Enrollment ID: I20220721003315 |
| Provider Name | Samuel D. Kang |
|---|---|
| Provider Type | Practitioner - Prosthodontics |
| Provider Identifiers | NPI Number: 1730758749 PECOS PAC ID: 6406294305 Enrollment ID: I20240410001935 |
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