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Organization
STONY ISLAND DENTALWORKS LLC
Active
Organization
STONY ISLAND DENTALWORKS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. REGINALD TORRANCE BAKER DDS (MANAGING MEMBER)
(773) 493-4937
Entity
Organization
Contact information
Practice address
2235 E 71ST ST, CHICAGO, IL 60649-2539
(773) 493-4937
(773) 675-4419
Mailing address
56 E 47TH ST STE 200, CHICAGO, IL 60653-3982
(773) 858-7481
(773) 675-4419
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
19-025166
IL
Other
Enumeration date
09/12/2017
Last updated
11/18/2019
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