Individual
MICHAEL KIRK SUBTELNY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
4401 W LAWRENCE AVE, CHICAGO, IL 60630-2510
(773) 725-6086
Mailing address
4401 W LAWRENCE AVE, CHICAGO, IL 60630-2510
(773) 725-6086
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
019.031632
IL
Other
Enumeration date
06/11/2018
Last updated
03/18/2021
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