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916 W Belmont Ave Suite 201 Chicago IL 60657-4427 | |
| (773) 929-1150 | |
| (773) 929-0831 |
| Full Name | |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 916 W Belmont Ave, Chicago, Illinois |
| Authorized Official Name and Position | Grace H Lee (DENTIST/OWNER) |
| Authorized Official Contact | 7739291150 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
916 W Belmont Ave Suite 201 Chicago IL 60657-4427 Ph: (773) 929-1150 | 916 W Belmont Ave Suite 201 Chicago IL 60657-4427 Ph: (773) 929-1150 |
| NPI Number | 1437456712 |
|---|---|
| Provider Enumeration Date | 02/22/2011 |
| Last Update Date | 02/22/2011 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1437456712 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | 019.026497 (Illinois) | Primary |
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