MEDICARE: GSDC INC

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	302R00000X	Health Maintenance Organization		IL

General Provider Information

NPI Number	:	1447265970
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GSDC INC

Provider Business Mailing Address
First Line	:	3524 W IRVING PARK RD
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60618-3210
Country	:	US
Telephone Number	:	773-588-4650
Fax Number	:	773-588-4631

Provider Business Practice Location Address
First Line	:	3524 W IRVING PARK RD
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60618-3210
Country	:	US
Telephone Number	:	773-588-4650
Fax Number	:	773-588-4631

Authorized Official
Title or Position	:	DENTIST
Name	:	DR. CHARISMA LUAT
Credential	:	DDS
Telephone Number	:	773-588-4650

Provider Enumeration Date	:	07/31/2006
Last Update Date	:	08/22/2020

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Directions to “GSDC INC ” Practice Location

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