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General NPI Number Information
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NPI Number | 1235305681
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Entity Type | Organization
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Legal Business Name | ACDI CHICAGO LLC
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Dates
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Enumeration Date | 05/06/2008
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Last Update Date | 08/07/2009
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Provider Practice Location Address
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Address Line | 625 N MICHIGAN AVE SUITE #1710
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City | CHICAGO
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State | IL
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Zip | 60611-3110
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Country | US
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Telephone | 312-440-9200
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Fax | 312-867-0865
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Provider Business Mailing Address
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Address Line | 625 N MICHIGAN AVE SUITE #1710
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City | CHICAGO
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State | IL
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Zip | 60611-3110
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Country | US
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Telephone | 312-440-9200
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Fax | 312-867-0865
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Authorized Official
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Title or Position | CHIEF FINANCIAL OFFICER
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Name | MRS. ZUZANA VITKOVA
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Credential |
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Telephone | 630-586-9483
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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 | 019013583
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 019.027884
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License Number State | IL
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