Organization
FAMILY DENTAL GROUP, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
IVANA BUENO (DIRECTOR)
(773) 798-9382
Entity
Organization
Contact information
Practice address
3855 W NORTH AVE, CHICAGO, IL 60647-4640
(773) 782-8900
(773) 782-0577
Mailing address
3855 W NORTH AVE, CHICAGO, IL 60647-4640
(773) 782-8900
(773) 782-0577
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
103156
—
IL
Enumeration date
03/15/2008
Last updated
01/07/2026
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