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Organization
WICKER PARK DENTAL, LTD
Active
Organization
WICKER PARK DENTAL, LTD
Active
Other names
Wicker Park Dental Group
Organization subpart
No
Provider details
NPI number
Authorized official
NIDZA ALICEA (OFFICE MANAGER)
(773) 235-0980
Entity
Organization
Contact information
Practice address
1738 W NORTH AVE, CHICAGO, IL 60622
(773) 276-5566
(773) 276-8780
Mailing address
1738 W. NORTH AVE, CHICAGO, IL 60622
(773) 276-5566
(773) 276-8780
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
060010054
IL
261QD0000X
Dental Clinic/Center
—
—
Other
Enumeration date
01/25/2007
Last updated
02/09/2009
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