Organization
PERIODONTICS AND IMPLANT DENTISTRY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
HECTOR CUMMINGS (OWNER)
(773) 582-0035
Entity
Organization
Contact information
Practice address
8559 S PULASKI RD, CHICAGO, IL 60652-3643
(773) 582-0035
Mailing address
8559 S PULASKI RD, CHICAGO, IL 60652-3643
Taxonomy
Speciality
Code
Description
License number
State
261QS0112X
Oral and Maxillofacial Surgery Clinic/Center
Primary
—
—
Other
Enumeration date
06/27/2018
Last updated
06/27/2018
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