Organization
BRIDGEPORT DENTAL SPECIALISTS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. STEVEN VONGLUEKIAT (OWNER)
(312) 791-0920
Entity
Organization
Contact information
Practice address
2959 S WALLACE ST, CHICAGO, IL 60616-3034
(312) 791-0920
(312) 842-5338
Mailing address
2959 S WALLACE ST, CHICAGO, IL 60616-3034
(312) 791-0920
(312) 842-5338
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
019027652
IL
Other
Enumeration date
09/13/2010
Last updated
09/13/2010
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