Organization
BELMONT AUSTIN DENTAL CLINIC LTD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. HOWARD M LICHTENSTEIN D.D.S. (PRESIDENT)
(773) 237-4291
Entity
Organization
Contact information
Practice address
6027 W BELMONT AVE, CHICAGO, IL 60634-5116
(773) 237-4291
Mailing address
6027 W BELMONT AVE, CHICAGO, IL 60634-5116
(773) 237-4291
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
019018134
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1356461529
—
IL
Enumeration date
11/18/2009
Last updated
11/18/2009
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