Healthcare Provider Details

I. General information

NPI: 1740464874
Provider Name (Legal Business Name): 1ST FAMILY DENTAL OF LINCOLN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/26/2007
Last Update Date: 12/26/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5206 N LINCOLN AVE
CHICAGO IL
60625-2406
US

IV. Provider business mailing address

5206 N LINCOLN AVE
CHICAGO IL
60625-2406
US

V. Phone/Fax

Practice location:
  • Phone: 773-728-5333
  • Fax: 773-739-4300
Mailing address:
  • Phone: 773-561-5106
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: VESNA BELKIC
Title or Position: GENERAL MANAGER
Credential:
Phone: 773-728-5333