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Organization
SRB DENTAL PC
Active
Organization
SRB DENTAL PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SHEILA RENEE' BROWN D.D.S. (PRESIDENT DOCTOR)
(312) 663-1890
Entity
Organization
Contact information
Practice address
850 S WABASH AVE, SUITE 250, CHICAGO, IL 60605-3641
(312) 663-1890
(312) 663-1895
Mailing address
PO BOX 6776, CHICAGO, IL 60680-6776
(312) 663-1890
(312) 663-1895
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
019019737
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2QF679
BCBS OF MASS
MA
01
—
994848
UNITED CONCORDIA
—
01
—
DNIL19737A
FEP
—
Enumeration date
01/05/2007
Last updated
06/21/2012
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