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NPI Code Detail

MEDICARE: ESSENTIAL DENTAL,P.C.

MEDICARE: ESSENTIAL DENTAL,P.C.
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 DentistryIL

General Provider Information

NPI Number : 1992880140
Entity Type Code : Organization
Provider Name (Legal Business Name) : ESSENTIAL DENTAL,P.C.
Provider Business Mailing Address
First Line : 255 E 103RD ST
Second Line :
City : CHICAGO
State : IL
Zip : 60628-2807
Country : US
Telephone Number : 773-468-4554
Fax Number : 773-468-4848
Provider Business Practice Location Address
First Line : 255 E 103RD ST
Second Line :
City : CHICAGO
State : IL
Zip : 60628-2807
Country : US
Telephone Number : 773-468-4554
Fax Number : 773-468-4848
Authorized Official
Title or Position : DENTIST
Name : DR. OPHELIA KAY CARLTON
Credential : D.D.S.
Telephone Number : 773-468-4554
Provider Enumeration Date : 10/26/2006
Last Update Date : 07/21/2022

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Directions to “ESSENTIAL DENTAL,P.C. ” Practice Location

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