Organization
PORTAGE PARK DENTAL STUDIO
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DARREN DWAYNE SIMPSON DDS (OWNER)
(708) 369-4076
Entity
Organization
Contact information
Practice address
5955 W IRVING PARK RD, CHICAGO, IL 60634-2618
(773) 481-9455
Mailing address
1224 LAURA LN, WOODRIDGE, IL 60517-5062
(708) 369-4076
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
04/02/2022
Last updated
04/02/2022
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