Portage Park Dental Associates, Ltd | |
5613 W Irving Park Rd Chicago IL 60634-2740 | |
(773) 286-4030 | |
(773) 736-0716 |
Full Name | Portage Park Dental Associates, Ltd |
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Speciality | Dentist |
Location | 5613 W Irving Park Rd, Chicago, Illinois |
Authorized Official Name and Position | Aneta Choma-dlouchy (PRESIDENT) |
Authorized Official Contact | 7732864030 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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Portage Park Dental Associates, Ltd 5613 W Irving Park Rd Chicago IL 60634-2740 Ph: (773) 286-4030 | Portage Park Dental Associates, Ltd 5613 W Irving Park Rd Chicago IL 60634-2740 Ph: (773) 286-4030 |
NPI Number | 1003124371 |
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Provider Enumeration Date | 09/20/2010 |
Last Update Date | 09/20/2010 |
Identifier | Type | State | Issuer |
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1003124371 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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122300000X | Dentist | 019026570 (Illinois) | Primary |
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