Organization
WICKER PARK DENTAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SUSAN STUART BROWN (OFFICE MANAGER)
(773) 276-5566
Entity
Organization
Contact information
Practice address
1738 W NORTH AVE, CHICAGO, IL 60622-2147
(773) 276-5566
(773) 276-8780
Mailing address
1738 W NORTH AVE, CHICAGO, IL 60622-2147
(773) 276-5566
(773) 276-8780
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
019016946
IL
Other
Enumeration date
11/16/2010
Last updated
11/16/2010
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