Organization
CHICAGOLAND DENTAL ASSOCIATES PC
Active
Other names
Bucktown Dental Associates
Organization subpart
No
Provider details
NPI number
Authorized official
YASSER ELSEWEIFI DDS (PRESIDENT)
(630) 464-1474
Entity
Organization
Contact information
Practice address
2002 N DAMEN AVE, CHICAGO, IL 60647-4527
(773) 276-2757
(773) 276-2758
Mailing address
2002 N DAMEN AVE, CHICAGO, IL 60647-4527
(773) 276-2757
(773) 276-2758
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
019023492
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1245429133
NPI
—
Enumeration date
06/25/2009
Last updated
10/01/2013
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