Healthcare Provider Details

I. General information

NPI: 1306514773
Provider Name (Legal Business Name): FAMILY DENTAL CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2021
Last Update Date: 09/01/2021
Certification Date: 08/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3009 E 92ND ST
CHICAGO IL
60617-4502
US

IV. Provider business mailing address

3009 E 92ND ST
CHICAGO IL
60617-4502
US

V. Phone/Fax

Practice location:
  • Phone: 773-295-2521
  • Fax:
Mailing address:
  • Phone: 773-295-2521
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL J GIULIANO
Title or Position: ASSOCIATE
Credential: DMD
Phone: 708-280-7341