Organization
CHICAGO AVENUE DENTAL GROUP LTD.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LEE STANSBURY D.D.S. (PRESIDENT)
(773) 276-0633
Entity
Organization
Contact information
Practice address
1802 W CHICAGO AVE, CHICAGO, IL 60622-5512
(773) 276-0633
(773) 276-0687
Mailing address
1802 W CHICAGO AVE, CHICAGO, IL 60622-5512
(773) 276-0633
(773) 276-0687
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
019016644
IL
Other
Enumeration date
12/02/2008
Last updated
12/02/2008
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