Organization
LAKESIDE DENTAL CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
HUSSAIN ALI DDS (OWNER)
(224) 366-0498
Entity
Organization
Contact information
Practice address
4945 W GRAND AVE, CHICAGO, IL 60639-4412
(224) 366-0498
Mailing address
2218 S MICHIGAN AVE, 2, CHICAGO, IL 60616-2126
(312) 842-7133
(312) 842-2082
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
019029848
IL
Other
Enumeration date
07/28/2014
Last updated
07/28/2014
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