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NPI Code Detail

MEDICARE: BRICKYARD DENTAL CENTER

MEDICARE: BRICKYARD DENTAL CENTER
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1122300000XDentistIL

General Provider Information

NPI Number : 1033381090
Entity Type Code : Organization
Provider Name (Legal Business Name) : BRICKYARD DENTAL CENTER
Provider Business Mailing Address
First Line : 6020 W DIVERSEY AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60639-1108
Country : US
Telephone Number : 773-237-0707
Fax Number : 773-622-6191
Provider Business Practice Location Address
First Line : 6020 W DIVERSEY AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60639-1108
Country : US
Telephone Number : 773-237-0707
Fax Number : 773-622-6191
Authorized Official
Title or Position : PRESIDENT
Name : DR. CHRISTOS A TSALIAGOS
Credential : D.D.S.
Telephone Number : 773-237-0707
Provider Enumeration Date : 03/31/2008
Last Update Date : 03/31/2008

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Directions to “BRICKYARD DENTAL CENTER ” Practice Location

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