Organization
UNIVERSITY OF ILLINOIS AT CHICAGO, DEPT OF PROSTHODONITCS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. STEPHANIE CLARKE (CLINIC DIRECTOR)
(312) 996-3535
Entity
Organization
Contact information
Practice address
801 S PAULINA ST, RM 361 DENT, CHICAGO, IL 60612-7210
(312) 355-0301
Mailing address
801 S PAULINA ST, RM 361 DENT, CHICAGO, IL 60612-7210
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
019.029461
IL
Other
Enumeration date
01/07/2016
Last updated
01/07/2016
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