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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