Organization
SONRISA DENTAL PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JASON KORKUS DDS (PRESIDENT)
(773) 484-1201
Entity
Organization
Contact information
Practice address
2001 S CALIFORNIA AVE, CHICAGO, IL 60608-2486
(773) 484-1201
(773) 484-1205
Mailing address
2001 S CALIFORNIA AVE, CHICAGO, IL 60608-2486
(773) 484-1201
(773) 484-1205
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
163914
—
IL
Enumeration date
07/16/2007
Last updated
07/16/2007
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