Organization
BOARD OF TRUSTEES OF THE UNIVERSITY OF ILLINOIS
Active
Parent organization
BOARD OF TRUSTEES OF THE UNIVERSITY OF ILLINOIS
Other names
UIC College of Dentistry
Organization subpart
Yes
Provider details
NPI number
Legal business name
BOARD OF TRUSTEES OF THE UNIVERSITY OF ILLINOIS
Authorized official
DAVID M CLARK BS, MA, DDS (ASSOCIATE DEAN FOR PATIENT SERVICES)
(312) 996-3544
Entity
Organization
Contact information
Practice address
801 S PAULINA ST, MC 621, CHICAGO, IL 60612-7210
(312) 996-7555
(312) 355-3864
Mailing address
801 S PAULINA ST, MC 621, CHICAGO, IL 60612-7210
(312) 996-7555
(312) 355-3864
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
—
—
1223E0200X
Endodontics
—
—
1223G0001X
General Practice Dentistry
—
—
1223P0221X
Pediatric Dentistry
—
—
1223P0300X
Periodontics
—
—
1223P0700X
Prosthodontics
—
—
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
—
—
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
—
—
Other
Enumeration date
11/30/2006
Last updated
12/12/2022
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