# CHICAGOLAND COMMUNITY PEDIATRIC DENTISTRY, P.C.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1497138135
- **Authorized official:** DR. ROSA N ORTEGA DDS (PEDIATRIC DENTIST)
- **Authorized official phone:** (847) 579-9013

## Contact information

- **Practice address:** 836 W WELLINGTON AVE, CHICAGO, IL 60657-5147
- **Practice address phone:** (847) 579-9013
- **Mailing address:** 5200 S MASSASOIT AVE, CHICAGO, IL 60638-1508

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223P0221X | Pediatric Dentistry | 019026478 | IL | Yes |

## Other

- **Enumeration date:** 06/30/2015
- **Last updated:** 06/30/2015