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1730 W Fullerton Ave Suite 26 Chicago IL 60614-1900 | |
| (773) 281-3000 | |
| (773) 281-3033 |
| Full Name | |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 1730 W Fullerton Ave, Chicago, Illinois |
| Authorized Official Name and Position | Grisel Yumira Rincon (OWNER) |
| Authorized Official Contact | 7732813000 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
1730 W Fullerton Ave Suite 26 Chicago IL 60614-1900 Ph: (773) 281-3000 | 1730 W Fullerton Ave Suite 26 Chicago IL 60614-1900 Ph: (773) 281-3000 |
| NPI Number | 1477822484 |
|---|---|
| Provider Enumeration Date | 12/20/2011 |
| Last Update Date | 12/20/2011 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1477822484 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 019027118 (Illinois) | Primary |
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