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NPI Code Detail

MEDICARE: BETSY H. ENRIQUEZ DENTAL SERVICES, LTD.

MEDICARE: BETSY H. ENRIQUEZ DENTAL SERVICES, LTD.
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
11223G0001XGeneral Practice Dentistry19A-14737IL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
119A-14737OTHERILLICENSE

General Provider Information

NPI Number : 1558413583
Entity Type Code : Organization
Provider Name (Legal Business Name) : BETSY H. ENRIQUEZ DENTAL SERVICES, LTD.
Provider Business Mailing Address
First Line : 736 W 35TH ST
Second Line :
City : CHICAGO
State : IL
Zip : 60616-4484
Country : US
Telephone Number : 773-247-3800
Fax Number : 847-720-4757
Provider Business Practice Location Address
First Line : 736 W 35TH ST
Second Line :
City : CHICAGO
State : IL
Zip : 60616-4484
Country : US
Telephone Number : 773-247-3800
Fax Number : 847-720-4757
Authorized Official
Title or Position : DENTIST
Name : DR. BETSY HELEN ENRIQUEZ
Credential : D.D.S.
Telephone Number : 773-247-3800
Provider Enumeration Date : 01/18/2007
Last Update Date : 03/31/2008

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Directions to “BETSY H. ENRIQUEZ DENTAL SERVICES, LTD. ” Practice Location

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