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2516 W Peterson Ave Chicago IL 60659-4109 | |
| (773) 743-4050 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Dentist |
| Location | 2516 W Peterson Ave, Chicago, Illinois |
| Authorized Official Name and Position | Ngoc-bich Nguyen (PRESIDENT) |
| Authorized Official Contact | 7737434050 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
2516 W Peterson Ave Chicago IL 60659-4109 Ph: () - | 2516 W Peterson Ave Chicago IL 60659-4109 Ph: (773) 743-4050 |
| NPI Number | 1922406446 |
|---|---|
| Provider Enumeration Date | 12/16/2014 |
| Last Update Date | 12/16/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1922406446 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 319016613 (Illinois) | Primary |
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