Organization
BRIDGEPORT DENTAL SMILES LLC
Active
Other names
Bridgeport Dental Smiles LLC
Organization subpart
No
Provider details
NPI number
Authorized official
OSCAR G GONZALEZ (DIRECTOR OF OPERATIONS)
(219) 465-8627
Entity
Organization
Contact information
Practice address
3014 S HALSTED ST, CHICAGO, IL 60608-5805
(219) 465-8627
Mailing address
3014 S HALSTED ST, CHICAGO, IL 60608-5805
(219) 465-8627
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
—
—
Other
Enumeration date
03/07/2019
Last updated
03/07/2019
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