# CITY KIDS DENTAL NORTH SHORE, LLC

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

## Provider details

- **NPI number:** 1629218557
- **Authorized official:** DR. A. MELISSA LOPEZ DMD, MPH (CO-OWNER)
- **Authorized official phone:** (847) 446-0950

## Contact information

- **Practice address:** 585 LINCOLN AVE, SUITE 2, WINNETKA, IL 60093-2351
- **Practice address phone:** (847) 446-0950
- **Practice address fax:** (847) 446-0985
- **Mailing address:** 585 LINCOLN AVE, SUITE 2, WINNETKA, IL 60093-2351
- **Mailing address phone:** (847) 446-0950
- **Mailing address fax:** (847) 446-0985

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223P0221X | Pediatric Dentistry | 019025964 | IL | Yes |

## Other

- **Enumeration date:** 03/05/2009
- **Last updated:** 08/16/2012