Organization
WICKER PARK ORTHODONTIA, LTD.
Active
Other names
Wicker Park Orthodontics
Organization subpart
No
Provider details
NPI number
Authorized official
NIDZA ALICEA (MANAGER)
(773) 235-0980
Entity
Organization
Contact information
Practice address
1921 W. NORTH AVE S, CHICAGO, IL 60622
(773) 276-5566
Mailing address
1921 W. NORTH AVE S, CHICAGO, IL 60622
(773) 276-0335
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
060010055
IL
Other
Enumeration date
02/20/2009
Last updated
02/20/2009
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