Organization
KRISHNA M GOPISETTY D.D.S., M.S., P.C.
Active
Other names
Wicker Park Dental Group
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KRISHNA M GOPISETTY D.D.S., M.S. (PRESIDENT)
(773) 276-5566
Entity
Organization
Contact information
Practice address
1738 W NORTH AVE, CHICAGO, IL 60622-2147
(773) 276-5566
Mailing address
1738 W NORTH AVE, CHICAGO, IL 60622-2147
(773) 276-5566
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
019029636
IL
Other
Enumeration date
12/21/2014
Last updated
12/21/2014
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