Organization
MODERN DENTAL ON DIVISION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PHILLIP PALELLA DDS (OWNER)
(773) 489-5700
Entity
Organization
Contact information
Practice address
2033 W. DIVISION, CHICAGO, IL 60622
(773) 489-5700
Mailing address
2033 W. DIVISION, CHICAGO, IL 60622
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
019.026403
IL
Other
Enumeration date
12/16/2013
Last updated
12/16/2013
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