MEDICARE: CHICAGO DENTAL SPECIALISTS PC

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
1	122300000X	Dentist

General Provider Information

NPI Number	:	1225997240
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHICAGO DENTAL SPECIALISTS PC

Provider Business Mailing Address
First Line	:	1222 W MADISON ST STE 300
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60607-2091
Country	:	US
Telephone Number	:	312-988-0025
Fax Number	:

Provider Business Practice Location Address
First Line	:	558 W WEBSTER AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60614-0900
Country	:	US
Telephone Number	:	773-820-9888
Fax Number	:

Authorized Official
Title or Position	:	REVENUE CYCLE MANAGER
Name	:	MRS. CRYSTAL BARRON
Credential	:
Telephone Number	:	813-580-0028

Provider Enumeration Date	:	01/16/2026
Last Update Date	:	05/07/2026

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Directions to “CHICAGO DENTAL SPECIALISTS PC ” Practice Location

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