| Lakeside Dental Center | |
|
4945 W Grand Ave Chicago IL 60639-4412 | |
| (224) 366-0498 | |
| Not Available |
| Full Name | Lakeside Dental Center |
|---|---|
| Speciality | Dentist |
| Location | 4945 W Grand Ave, Chicago, Illinois |
| Authorized Official Name and Position | Hussain Ali (OWNER) |
| Authorized Official Contact | 2243660498 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Lakeside Dental Center 2218 S Michigan Ave 2 Chicago IL 60616-2126 Ph: (312) 842-7133 | Lakeside Dental Center 4945 W Grand Ave Chicago IL 60639-4412 Ph: (224) 366-0498 |
| NPI Number | 1063820694 |
|---|---|
| Provider Enumeration Date | 07/28/2014 |
| Last Update Date | 07/28/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1063820694 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 019029848 (Illinois) | Primary |
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