Organization
DIVERSEY DENTAL CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. VERONICA HERNANDEZ (OFFICE MANAGER)
(773) 202-1500
Entity
Organization
Contact information
Practice address
5300 W DIVERSEY AVE, CHICAGO, IL 60639
(773) 202-1500
(773) 202-1697
Mailing address
5300 W DIVERSEY AVE, CHICAGO, IL 60639
(773) 202-1500
(773) 202-1697
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
—
IL
Other
Enumeration date
02/06/2007
Last updated
08/22/2020
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