Organization
BIC NGUYEN DDS PC
Active
Other names
Lake Shore Dental Care
Organization subpart
No
Provider details
NPI number
Authorized official
MISS NGOC-BICH THI NGUYEN DDS (PRESIDENT)
(773) 369-5536
Entity
Organization
Contact information
Practice address
834 W MONTROSE AVE # 101, CHICAGO, IL 60613-5813
(773) 989-9160
Mailing address
834 W MONTROSE AVE # 101, CHICAGO, IL 60613-5813
(773) 989-9160
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
019027633
IL
Other
Enumeration date
03/17/2011
Last updated
03/17/2011
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