Organization
HUMBOLDT COMMUNITY DENTAL PC
Active
Other names
Sonrisa Family Dental
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JASON KORKUS DDS (PRESIDENT)
(773) 772-9200
Entity
Organization
Contact information
Practice address
1044 N MOZART ST, SUITE 401, CHICAGO, IL 60622-2789
(773) 772-9200
(773) 772-9203
Mailing address
1044 N MOZART ST, SUITE 401, CHICAGO, IL 60622-2789
(773) 772-9200
(773) 772-9203
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
07/25/2007
Last updated
07/25/2007
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