| Lakeshore Dental Studio | |
|
5505 N Clark St Chicago IL 60640-1213 | |
| (989) 714-3142 | |
| Not Available |
| Full Name | Lakeshore Dental Studio |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 5505 N Clark St, Chicago, Illinois |
| Authorized Official Name and Position | Kapil Kella (DENTIST/OWNER) |
| Authorized Official Contact | 9897143142 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Lakeshore Dental Studio 1630 Chicago Ave Apt 1302 Evanston IL 60201-4593 Ph: (989) 714-3142 | Lakeshore Dental Studio 5505 N Clark St Chicago IL 60640-1213 Ph: (989) 714-3142 |
| NPI Number | 1134625031 |
|---|---|
| Provider Enumeration Date | 04/01/2018 |
| Last Update Date | 04/01/2018 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1134625031 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 019.029212 (Illinois) | Primary |
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