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1624 W Montrose Ave Chicago IL 60613-1214 | |
| (773) 275-5600 | |
| (773) 275-5868 |
| Full Name | |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 1624 W Montrose Ave, Chicago, Illinois |
| Authorized Official Name and Position | Salman Umar Poothawala (DENTIST) |
| Authorized Official Contact | 7732755600 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
1624 W Montrose Ave Chicago IL 60613-1214 Ph: (773) 275-5600 | 1624 W Montrose Ave Chicago IL 60613-1214 Ph: (773) 275-5600 |
| NPI Number | 1083885271 |
|---|---|
| Provider Enumeration Date | 03/17/2008 |
| Last Update Date | 03/17/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1083885271 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 019026329 (Illinois) | Primary |
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