Organization
CUSP DENTAL STUDIO PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JACKIE JONES (MANAGER)
(773) 687-8052
Entity
Organization
Contact information
Practice address
3917 N ASHLAND AVE, CHICAGO, IL 60613-5233
(773) 687-8052
Mailing address
3917 N ASHLAND AVE, CHICAGO, IL 60613-5233
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
019-026174
IL
1223G0001X
General Practice Dentistry
019-029332
IL
1223G0001X
General Practice Dentistry
019-030017
IL
Other
Enumeration date
08/30/2016
Last updated
08/30/2016
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