| Stony Island Dentalworks Llc | |
|
2235 E 71st St Chicago IL 60649-2539 | |
| (773) 493-4937 | |
| (773) 675-4419 |
| Full Name | Stony Island Dentalworks Llc |
|---|---|
| Speciality | Dentist |
| Location | 2235 E 71st St, Chicago, Illinois |
| Authorized Official Name and Position | Reginald Torrance Baker (MANAGING MEMBER) |
| Authorized Official Contact | 7734934937 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Stony Island Dentalworks Llc 56 E 47th St Ste 200 Chicago IL 60653-3982 Ph: (773) 858-7481 | Stony Island Dentalworks Llc 2235 E 71st St Chicago IL 60649-2539 Ph: (773) 493-4937 |
| NPI Number | 1922527852 |
|---|---|
| Provider Enumeration Date | 09/12/2017 |
| Last Update Date | 11/18/2019 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1922527852 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 19-025166 (Illinois) | Primary |
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