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General NPI Number Information
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NPI Number | 1255457214
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Entity Type | Organization
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Legal Business Name | J J MITCHELL DENTAL GROUP
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Dates
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Enumeration Date | 03/21/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1525 E 53RD ST SUITE 821
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City | CHICAGO
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State | IL
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Zip | 60615-4557
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Country | US
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Telephone | 773-955-0355
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Fax | 773-955-1175
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Provider Business Mailing Address
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Address Line | 1525 E 53RD ST SUITE 821
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City | CHICAGO
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State | IL
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Zip | 60615-4557
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Country | US
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Telephone | 773-955-0355
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Fax | 773-955-1175
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Authorized Official
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Title or Position | DENTIST
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Name | DR. JEFFERY C, SAFFOLD
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Credential | DDS
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Telephone | 773-955-0355
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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 | 019-19340
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License Number State | IL
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