| Full Name | |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 3059 S 26th St, Chicago, Illinois |
| Authorized Official Name and Position | Mary Lukaszczyk (CHIEF OPERATING OFFICER) |
| Authorized Official Contact | 6307303233 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
3059 South 26th Street Chicago IL 60623 Ph: (773) 247-7600 | 3059 S 26th St Chicago IL 60623 Ph: (773) 247-7600 |
| NPI Number | 1982019204 |
|---|---|
| Provider Enumeration Date | 06/25/2014 |
| Last Update Date | 06/25/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1982019204 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | (* (Not Available)) | Primary |
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