Healthcare Provider Details

I. General information

NPI: 1558285296
Provider Name (Legal Business Name): MAGDALYNN FINE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2026
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3014 S HALSTED ST
CHICAGO IL
60608-5805
US

IV. Provider business mailing address

3014 S HALSTED ST
CHICAGO IL
60608-5805
US

V. Phone/Fax

Practice location:
  • Phone: 312-827-6464
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number019037399
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: