Organization
OLD TOWN DENTAL CARE, P.C.
Active
Other names
Lakeview Dental Care, P.C.
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SAM TAHBAZ DDS (PRESIDENT)
(312) 573-0007
Entity
Organization
Contact information
Practice address
1504 N WELLS ST, CHICAGO, IL 60610-1308
(312) 573-0007
(312) 573-0002
Mailing address
1504 N WELLS ST, CHICAGO, IL 60610-1308
(312) 573-0007
(312) 573-0002
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
019024892
IL
Other
Enumeration date
12/03/2008
Last updated
12/03/2008
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