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Organization
HUMBOLDT COMMUNITY DENTAL PC
Active
Organization
HUMBOLDT COMMUNITY DENTAL PC
Active
Other names
Sonrisa Family Dental
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JASON KORKUS DDS (PRESIDENT)
(773) 772-9200
Entity
Organization
Contact information
Practice address
1044 N MOZART ST, SUITE 401, CHICAGO, IL 60622-2789
(773) 772-9200
(773) 772-9203
Mailing address
1044 N MOZART ST, SUITE 401, CHICAGO, IL 60622-2789
(773) 772-9200
(773) 772-9203
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
163914
—
IL
Enumeration date
07/25/2007
Last updated
07/25/2007
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