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Organization
SUBURBAN FAMILY DENTAL CENTER, INC.
Active
Organization
SUBURBAN FAMILY DENTAL CENTER, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LOIDA TICZON PREZA D.M.D (PRESIDENT)
(773) 769-8195
Entity
Organization
Contact information
Practice address
5214 N WESTERN AVE, SUITE 303, CHICAGO, IL 60625-2589
(773) 769-8195
Mailing address
5214 N WESTERN AVE, SUITE 303, CHICAGO, IL 60625-2589
(773) 769-8195
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
019022955
IL
Other
Enumeration date
02/28/2007
Last updated
04/15/2012
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