Healthcare Provider Details

I. General information

NPI: 1144184771
Provider Name (Legal Business Name): DENTAL TOWN LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/09/2025
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3346 W LAWRENCE AVE
CHICAGO IL
60625-5212
US

IV. Provider business mailing address

3346 W LAWRENCE AVE
CHICAGO IL
60625-5212
US

V. Phone/Fax

Practice location:
  • Phone: 773-797-2000
  • Fax:
Mailing address:
  • Phone: 773-797-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: SAMANTHA GONZALEZ
Title or Position: VP OF OPERATIONS
Credential:
Phone: 708-713-5000