Healthcare Provider Details

I. General information

NPI: 1386577641
Provider Name (Legal Business Name): CHICAGO WISDOM TEETH, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2026
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

722 S PRESIDENT ST STE A
WHEATON IL
60189-6606
US

IV. Provider business mailing address

5513 W 11000 N STE 226
HIGHLAND UT
84003-8012
US

V. Phone/Fax

Practice location:
  • Phone: 312-584-1155
  • Fax:
Mailing address:
  • Phone: 312-584-1155
  • Fax: 312-283-4602

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State

VIII. Authorized Official

Name: MR. BENJAMIN HILTON
Title or Position: MANAGING MEMBER
Credential: DDS
Phone: 208-484-2376