Organization
MODERN DENTAL ON CLARK STREET
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. PHILLIP PALELLA DDS (OWNER)
(773) 489-5700
Entity
Organization
Contact information
Practice address
744 N CLARK ST, CHICAGO, IL 60654-2525
(773) 489-5700
Mailing address
2037 W DIVISION ST, CHICAGO, IL 60622-3157
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
261QD0000X
Dental Clinic/Center
—
—
305R00000X
Preferred Provider Organization
—
—
Other
Enumeration date
06/18/2017
Last updated
06/18/2017
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