MEDICARE: DR. CHRIS P. ULLMANN 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	1223G0001X	General Practice Dentistry		IL

General Provider Information

NPI Number	:	1689887861
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHRIS P. ULLMANN D.D.S.

Provider Business Mailing Address
First Line	:	6121 WASHINGTON ST
Second Line	:	SUITE 202
City	:	GURNEE
State	:	IL
Zip	:	60031-5305
Country	:	US
Telephone Number	:	847-625-9897
Fax Number	:	847-625-9961

Provider Business Practice Location Address
First Line	:	6121 WASHINGTON ST
Second Line	:	SUITE 202
City	:	GURNEE
State	:	IL
Zip	:	60031-5305
Country	:	US
Telephone Number	:	847-625-9897
Fax Number	:	847-625-9961

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

Provider Enumeration Date	:	05/07/2007
Last Update Date	:	07/08/2007

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