| Sprout Pediatric Dentistry | |
|
6036 North Northwest Highway Chicago IL 60631 | |
| (773) 377-5658 | |
| (773) 409-4663 |
| Full Name | Sprout Pediatric Dentistry |
|---|---|
| Speciality | Dentist |
| Location | 6036 North Northwest Highway, Chicago, Illinois |
| Authorized Official Name and Position | Johnny I Kuttab (DENTIST) |
| Authorized Official Contact | 7733775658 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Sprout Pediatric Dentistry 6036 N. Northwest Higway Chicago IL 60631 Ph: (773) 377-5658 | Sprout Pediatric Dentistry 6036 North Northwest Highway Chicago IL 60631 Ph: (773) 377-5658 |
| NPI Number | 1538512884 |
|---|---|
| Provider Enumeration Date | 07/21/2016 |
| Last Update Date | 07/21/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1538512884 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 021002373 (Illinois) | Primary |
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