Organization
MADISON PINE DENTAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JAMES POULOS (DENTIST)
(773) 287-3939
Entity
Organization
Contact information
Practice address
5470 W MADISON ST, CHICAGO, IL 60644-4031
(773) 287-3939
(773) 287-2573
Mailing address
5470 W MADISON ST, CHICAGO, IL 60644-4031
(773) 287-3939
(773) 287-2573
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
04/04/2007
Last updated
08/22/2020
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