Organization
PEDIATRIC DENTAL SURGICAL ASSOCIATES PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOHNNY KUTTAB (CEO)
(773) 423-6050
Entity
Organization
Contact information
Practice address
2550 W ADDISON ST, CHICAGO, IL 60618-5952
(773) 423-6050
Mailing address
2550 W ADDISON ST, CHICAGO, IL 60618-5952
(773) 423-6050
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
—
—
Other
Enumeration date
01/04/2019
Last updated
01/04/2019
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