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Organization
UNIVERSITY OF ILLINOIS AT CHICAGO, DEPT OF PROSTHODONITCS
Active
Organization
UNIVERSITY OF ILLINOIS AT CHICAGO, DEPT OF PROSTHODONITCS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. STEPHANIE CLARKE (CLINIC DIRECTOR)
(312) 996-3535
Entity
Organization
Contact information
Practice address
801 S PAULINA ST, RM 361 DENT, CHICAGO, IL 60612-7210
(312) 355-0301
Mailing address
801 S PAULINA ST, RM 361 DENT, CHICAGO, IL 60612-7210
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
019.029461
IL
Other
Enumeration date
01/07/2016
Last updated
01/07/2016
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