Organization
OLD TOWN DENTAL CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. VLAD FERDKOFF (PRESIDENT)
(312) 751-1113
Entity
Organization
Contact information
Practice address
333 W NORTH AVE, CHICAGO, IL 60610-1293
(312) 751-1113
Mailing address
333 W NORTH AVE, CHICAGO, IL 60610-1293
(312) 751-1113
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
019024754
IL
Other
Enumeration date
03/30/2010
Last updated
03/30/2010
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