Organization
FRATMISHIN J. ALEXANDER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
AUGANIA JOHN ALEXANDER (OFFICE MANAGER)
(773) 338-6565
Entity
Organization
Contact information
Practice address
6408 N CALIFORNIA AVE, CHICAGO, IL 60645-5209
(773) 338-6565
(773) 338-6552
Mailing address
PO BOX 597770, CHICAGO, IL 60659-7770
(773) 338-6565
(773) 338-6552
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1001041
—
IL
Enumeration date
04/19/2018
Last updated
04/19/2018
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