| Tooth Fairy World Pc | |
|
2069 North Clybourn Avenue Chicago IL 60614 | |
| (773) 327-3331 | |
| (773) 868-6453 |
| Full Name | Tooth Fairy World Pc |
|---|---|
| Speciality | Dentist - Pediatric Dentistry |
| Location | 2069 North Clybourn Avenue, Chicago, Illinois |
| Authorized Official Name and Position | Marylene Vitiello (PRESIDENT OF CORPORATION) |
| Authorized Official Contact | 7733273331 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Tooth Fairy World Pc 2069 N Clybourn Ave Chicago IL 60614 Ph: (773) 327-3331 | Tooth Fairy World Pc 2069 North Clybourn Avenue Chicago IL 60614 Ph: (773) 327-3331 |
| NPI Number | 1811055072 |
|---|---|
| Provider Enumeration Date | 12/04/2006 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1811055072 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0221X | Dentist - Pediatric Dentistry | (Illinois) | Primary |
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