Organization
GREEN TREE DENTAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SEUNG-HOON LEE (OWNER)
(773) 661-9722
Entity
Organization
Contact information
Practice address
3309 W NORTH AVE, CHICAGO, IL 60647-4901
(773) 661-9722
Mailing address
659 W RANDOLPH ST APT 1414, CHICAGO, IL 60661-2248
(619) 742-6471
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
04/27/2019
Last updated
04/27/2019
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