Healthcare Provider Details

I. General information

NPI: 1679987622
Provider Name (Legal Business Name): GEORGE JOSEPH DDS MS LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2014
Last Update Date: 06/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3171 W MADISON ST
CHICAGO IL
60612-1809
US

IV. Provider business mailing address

3171 W MADISON ST
CHICAGO IL
60612-1809
US

V. Phone/Fax

Practice location:
  • Phone: 773-533-2332
  • Fax: 630-242-2990
Mailing address:
  • Phone: 773-533-2332
  • Fax: 630-242-2990

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: DR. GEORGE JOSEPH
Title or Position: PRESIDENT
Credential: DDS
Phone: 773-533-2332