Organization
BRIDGEPORT SMILES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. NEEPA MODI DDS (OWNER)
(312) 291-9283
Entity
Organization
Contact information
Practice address
3014 S HALSTED ST, CHICAGO, IL 60608-5805
(312) 291-9283
Mailing address
3014 S HALSTED ST, CHICAGO, IL 60608-5805
(312) 291-9283
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
019026249
IL
Other
Enumeration date
04/09/2014
Last updated
09/02/2014
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