Organization
PORTAGE PARK DENTAL ASSOCIATES, LTD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ANETA CHOMA-DLOUCHY DDS (PRESIDENT)
(773) 286-4030
Entity
Organization
Contact information
Practice address
5613 W IRVING PARK RD, CHICAGO, IL 60634-2740
(773) 286-4030
(773) 736-0716
Mailing address
5613 W IRVING PARK RD, CHICAGO, IL 60634-2740
(773) 286-4030
(773) 736-0716
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
019026570
IL
Other
Enumeration date
09/20/2010
Last updated
09/20/2010
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