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Organization
SKYLINE SMILES OF ROSCOE VILLAGE LLC
Active
Organization
SKYLINE SMILES OF ROSCOE VILLAGE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DEEPAK NEDUVELIL DDS (OWNER)
(312) 759-1120
Entity
Organization
Contact information
Practice address
2125 W ROSCOE ST, UNIT A, CHICAGO, IL 60618-6219
(312) 759-1120
(312) 624-9217
Mailing address
2125 W ROSCOE ST, UNIT A, CHICAGO, IL 60618-6219
(312) 759-1120
(312) 624-9217
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
019027964
IL
Other
Enumeration date
04/26/2016
Last updated
04/26/2016
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