Organization
JEFFERSON PARK FAMILY DENTAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ROBERT CORY STITES (INSURANCE COORDINATOR-DECISION ONE)
(630) 869-5857
Entity
Organization
Contact information
Practice address
4452 N CENTRAL AVE, CHICAGO, IL 60630-3302
(773) 777-4800
(773) 777-4918
Mailing address
4452 N CENTRAL AVE, CHICAGO, IL 60630-3302
(773) 777-4800
(773) 777-4918
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
07/08/2021
Last updated
01/13/2023
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