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3052 N Lincoln Ave Chicago IL 60657-4286 | |
| (773) 997-1979 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 3052 N Lincoln Ave, Chicago, Illinois |
| Authorized Official Name and Position | Jared Benjamin Siegel (DENTIST) |
| Authorized Official Contact | 6313748567 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
3052 N Lincoln Ave Chicago IL 60657-4286 Ph: (773) 997-1979 | 3052 N Lincoln Ave Chicago IL 60657-4286 Ph: (773) 997-1979 |
| NPI Number | 1073249769 |
|---|---|
| Provider Enumeration Date | 07/26/2022 |
| Last Update Date | 01/21/2025 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1073249769 | NPI | - | NPPES |
| 1740818848 | Medicaid | IL | |
| 1740818848 | Other | IL | INSURANCE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (* (Not Available)) | Primary |
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