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General NPI Number Information
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NPI Number | 1225518921
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Entity Type | Organization
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Legal Business Name | BERWYN DENTAL INC.
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Dates
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Enumeration Date | 08/21/2018
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Last Update Date | 08/21/2018
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Provider Practice Location Address
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Address Line | 6218 CERMAK RD
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City | BERWYN
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State | IL
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Zip | 60402-2322
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Country | US
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Telephone | 708-317-5150
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Fax |
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Provider Business Mailing Address
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Address Line | 6218 CERMAK RD
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City | BERWYN
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State | IL
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Zip | 60402-2322
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. NGOC BICH NGUYEN
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Credential | DDS
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Telephone | 773-369-5536
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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