MEDICARE: DR. CHRISTOPHER STORTI D.D.S.

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	019029757	IL

General Provider Information

NPI Number	:	1346688074
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHRISTOPHER STORTI D.D.S.

Provider Business Mailing Address
First Line	:	1170 W ARMITAGE AVE
Second Line	:	APT 3W
City	:	CHICAGO
State	:	IL
Zip	:	60614-6385
Country	:	US
Telephone Number	:	847-561-5475
Fax Number	:

Provider Business Practice Location Address
First Line	:	3703 W LAKE AVE
Second Line	:	SUITE 100
City	:	GLENVIEW
State	:	IL
Zip	:	60026-5823
Country	:	US
Telephone Number	:	847-998-5550
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/04/2013
Last Update Date	:	07/27/2015

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