Individual
DR. CLARISSA COUCH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
10220 S 76TH AVE, SUITE 250, BRIDGEVIEW, IL 60455-2425
(708) 974-6160
Mailing address
2020W HARRISON ST, CHICAGO, IL 60612-3741
(312) 572-4788
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
019-022817
IL
1223D0001X
Public Health Dentistry
019022817
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
101942
TIN
IL
Enumeration date
02/28/2007
Last updated
04/22/2021
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