| Spang Dental Center West | |
|
2418 W Division St Chicago IL 60622-2940 | |
| (773) 252-6413 | |
| (773) 252-6417 |
| Full Name | Spang Dental Center West |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 2418 W Division St, Chicago, Illinois |
| Authorized Official Name and Position | Heidi Nelson (CONTROLLER) |
| Authorized Official Contact | 7737514107 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Spang Dental Center West 4750 N Sheridan Rd Suite 434 Chicago IL 60640-7528 Ph: (773) 751-1704 | Spang Dental Center West 2418 W Division St Chicago IL 60622-2940 Ph: (773) 252-6413 |
| NPI Number | 1447417118 |
|---|---|
| Provider Enumeration Date | 05/20/2008 |
| Last Update Date | 05/20/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1447417118 | NPI | - | NPPES |
| 103326 | Other | IL | DORAL DENTAL |
| 017 | Medicaid | IL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 017 (Illinois) | Primary |
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