Organization
HEARTLAND HEALTH OUTREACH
Active
Other names
Spang Dental Center West
Organization subpart
No
Provider details
NPI number
Authorized official
HEIDI NELSON (CONTROLLER)
(773) 751-4107
Entity
Organization
Contact information
Practice address
2418 W DIVISION ST, CHICAGO, IL 60622-2940
(773) 252-6413
(773) 252-6417
Mailing address
4750 N SHERIDAN RD, SUITE 434, CHICAGO, IL 60640-7528
(773) 751-1704
(773) 751-4175
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
017
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
017
—
IL
01
—
103326
DORAL DENTAL
IL
Enumeration date
05/20/2008
Last updated
05/20/2008
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