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13247 S Baltimore Ave Chicago IL 60633-1431 | |
| (773) 646-4664 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 13247 S Baltimore Ave, Chicago, Illinois |
| Authorized Official Name and Position | Abhishek Nagaraj (OWNER) |
| Authorized Official Contact | 3123849493 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
950 N Clark St Unit I Chicago IL 60610-8702 Ph: () - | 13247 S Baltimore Ave Chicago IL 60633-1431 Ph: (773) 646-4664 |
| NPI Number | 1316463375 |
|---|---|
| Provider Enumeration Date | 08/21/2017 |
| Last Update Date | 08/21/2017 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1316463375 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 019029975 (Illinois) | Primary |
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