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1545 W North Ave Chicago IL 60642-2530 | |
| (312) 584-0355 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 1545 W North Ave, Chicago, Illinois |
| Authorized Official Name and Position | Vladik Crutcher (PRESIDENT) |
| Authorized Official Contact | 3125840355 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
1545 W North Ave Chicago IL 60642-2530 Ph: () - | 1545 W North Ave Chicago IL 60642-2530 Ph: (312) 584-0355 |
| NPI Number | 1144873506 |
|---|---|
| Provider Enumeration Date | 07/24/2019 |
| Last Update Date | 03/06/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1144873506 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | (* (Not Available)) | Primary |
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