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Organization
SONRISA FAMILY DENTAL ON KEDZIE PC
Active
Organization
SONRISA FAMILY DENTAL ON KEDZIE PC
Active
Other names
Sonrisa Family Dental
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JASON KORKUS DDS (PRESIDENT)
(773) 778-2200
Entity
Organization
Contact information
Practice address
5050 S KEDZIE AVE, CHICAGO, IL 60632-3009
(773) 778-2200
Mailing address
5050 S KEDZIE AVE, CHICAGO, IL 60632-3009
(773) 778-2200
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
01902511
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1004606
—
IL
Enumeration date
04/11/2008
Last updated
04/11/2008
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