MEDICARE: DENTIST ON THE PARK, 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	261QD0000X	Dental Clinic/Center	019029186	IL

General Provider Information

NPI Number	:	1952890691
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DENTIST ON THE PARK, INC.

Provider Business Mailing Address
First Line	:	8 S MICHIGAN AVE STE 1306
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60603-3377
Country	:	US
Telephone Number	:	872-888-9010
Fax Number	:	872-888-9015

Provider Business Practice Location Address
First Line	:	8 S MICHIGAN AVE STE 1306
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60603-3377
Country	:	US
Telephone Number	:	872-888-9010
Fax Number	:	872-888-9015

Authorized Official
Title or Position	:	OWNER DENTIST
Name	:	DR. ERIC M SCHOENING
Credential	:	DDS
Telephone Number	:	872-888-9010

Provider Enumeration Date	:	05/08/2018
Last Update Date	:	05/08/2018

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