MEDICARE: LITTLE CHOMPERS PEDIATRIC DENTISTRY

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	1223P0221X	Pediatric Dentistry

General Provider Information

NPI Number	:	1417664020
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LITTLE CHOMPERS PEDIATRIC DENTISTRY

Provider Business Mailing Address
First Line	:	5305 N CLARK ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60640-2113
Country	:	US
Telephone Number	:	312-471-6430
Fax Number	:	312-471-6431

Provider Business Practice Location Address
First Line	:	5305 N CLARK ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60640-2113
Country	:	US
Telephone Number	:	312-471-6430
Fax Number	:	312-471-6431

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	DR. MICHAEL P RABINOWITZ
Credential	:	DDS
Telephone Number	:	847-962-6321

Provider Enumeration Date	:	11/02/2022
Last Update Date	:	11/02/2022

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