Organization
HOWARD BROWN HEALTH CENTER
Active
Organization
HOWARD BROWN HEALTH CENTER
Active
Other names
Howard Brown Health 63rd St Oral Health Services
Organization subpart
No
Provider details
NPI number
Authorized official
BURGUNDY JOHNSON (CREDENTIALING)
(872) 629-3491
Entity
Organization
Contact information
Practice address
641 W 63RD ST BSMT, CHICAGO, IL 60621-2032
(773) 388-1600
(773) 388-8936
Mailing address
4025 N SHERIDAN RD, CHICAGO, IL 60613-2010
(773) 388-1600
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
—
—
1223G0001X
General Practice Dentistry
—
—
1223P0221X
Pediatric Dentistry
—
—
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Enumeration date
05/01/2017
Last updated
04/10/2025
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