Organization
CHICAGO PEDIATRIC DENTISTRY AND ORTHODONTICS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JUSTIN WELKE DDS (OWNER)
(630) 886-1780
Entity
Organization
Contact information
Practice address
1136 S DELANO CT W STE B202, CHICAGO, IL 60605-3734
(312) 766-0995
Mailing address
1136 S DELANO CT W STE B202, CHICAGO, IL 60605-3734
(312) 766-0995
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
—
—
261QD0000X
Dental Clinic/Center
—
—
Other
Enumeration date
11/03/2020
Last updated
11/03/2020
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