Organization
GENTLE DENTAL CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARILYS VALCOURT EWA DDS,MPH (PRESIDENT)
(708) 307-8844
Entity
Organization
Contact information
Practice address
2917 W 63RD ST, CHICAGO, IL 60629-2729
(773) 476-8217
(773) 476-8251
Mailing address
2917 W 63RD ST, CHICAGO, IL 60629-2729
(773) 476-8217
(773) 476-8251
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
019022941
IL
Other
Enumeration date
09/01/2015
Last updated
09/01/2015
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