| Panos Dentistry Center Inc. | |
|
4849 N. Milwaukee Ave Suite 103 Chicago IL 60630-2171 | |
| (773) 577-2100 | |
| Not Available |
| Full Name | Panos Dentistry Center Inc. |
|---|---|
| Speciality | Dentist - Orthodontics And Dentofacial Orthopedics |
| Location | 4849 N. Milwaukee Ave, Chicago, Illinois |
| Authorized Official Name and Position | Sue Pelletier (ADMIN ASSISTANCE) |
| Authorized Official Contact | 7735772100 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Panos Dentistry Center Inc. 4849 N. Milwaukee Ave Suite 103 Chicago IL 60630-2171 Ph: (773) 577-2100 | Panos Dentistry Center Inc. 4849 N. Milwaukee Ave Suite 103 Chicago IL 60630-2171 Ph: (773) 577-2100 |
| NPI Number | 1447568977 |
|---|---|
| Provider Enumeration Date | 09/17/2010 |
| Last Update Date | 09/17/2010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1447568977 | NPI | - | NPPES |
| 1104979533 | Other | IL | NATIONAL PROVIDER NUMBER |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 019-020397 (Illinois) | Secondary |
| 1223X0400X | Dentist - Orthodontics And Dentofacial Orthopedics | 021-000547 (Illinois) | Primary |
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