Healthcare Provider Details

I. General information

NPI: 1871388181
Provider Name (Legal Business Name): BRIAN CELESTIN BABULIC DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/09/2025
Last Update Date: 08/18/2025
Certification Date: 08/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

913 W WELLINGTON AVE
CHICAGO IL
60657-6709
US

IV. Provider business mailing address

913 W WELLINGTON AVE
CHICAGO IL
60657-6709
US

V. Phone/Fax

Practice location:
  • Phone: 773-871-2188
  • Fax:
Mailing address:
  • Phone: 773-871-2188
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number019.036145
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code261QS0112X
TaxonomyOral and Maxillofacial Surgery Clinic/Center
License Number019.036145
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: