Organization
IDA MAE DENTAL CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SHONNA RENEE CURRY DDS. (DENTAL DIRECTOR)
(773) 951-5650
Entity
Organization
Contact information
Practice address
8941 S WESTERN AVE, CHICAGO, IL 60643-6432
(773) 951-5650
Mailing address
8408 S SANGAMON ST, CHICAGO, IL 60620-3211
(773) 951-5650
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
019-025956
IL
Other
Enumeration date
01/18/2018
Last updated
01/18/2018
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