Individual
AMANDA PRENTICE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
820 S DAMEN AVE FL 4, CHICAGO, IL 60612-3728
(312) 569-6669
Mailing address
1104 W MADISON ST APT 3N, CHICAGO, IL 60607-2029
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
018002085
IL
Other
Enumeration date
11/15/2018
Last updated
11/15/2018
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