Organization
ALLCARE ORTHODONTIC CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BUDI KUSNOTO DDS, MS (PRESIDENT)
(312) 804-8304
Entity
Organization
Contact information
Practice address
842 W 31ST ST, CHICAGO, IL 60608-5837
(312) 804-8304
Mailing address
47 W POLK ST STE 251, CHICAGO, IL 60605-2000
(312) 804-8304
(312) 873-3803
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
019026824
IL
Other
Enumeration date
02/07/2014
Last updated
02/07/2014
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