Organization
CHICAGO DENTAL PROFESSIONALS INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANDREW T WEISS DDS MS (PRESIDENT)
(773) 528-2205
Entity
Organization
Contact information
Practice address
2340 N CLYBOURN, CHICAGO, IL 60614
(773) 528-2205
(773) 528-2216
Mailing address
2340 N CLYBOURN, CHICAGO, IL 60614
(773) 528-2205
(773) 528-2216
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
019014591
IL
122300000X
Dentist
019017259
IL
122300000X
Dentist
019020453
IL
1223P0221X
Pediatric Dentistry
019028564
IL
1223P0221X
Pediatric Dentistry
021000499
IL
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
021000831
IL
Other
Enumeration date
07/30/2006
Last updated
12/29/2011
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