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General NPI Number Information
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NPI Number | 1255503462
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Entity Type | Organization
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Legal Business Name | SO-WELL DENTAL ASSOCIATES,P.C.
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Dates
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Enumeration Date | 03/27/2008
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Last Update Date | 03/27/2008
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Provider Practice Location Address
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Address Line | 1122 N CLARK ST SUITE 1
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City | CHICAGO
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State | IL
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Zip | 60610-2857
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Country | US
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Telephone | 312-944-9355
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Fax | 312-944-7328
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Provider Business Mailing Address
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Address Line | 1122 N CLARK ST SUITE 1
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City | CHICAGO
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State | IL
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Zip | 60610-2857
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Country | US
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Telephone | 312-944-9355
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Fax | 312-944-7328
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ZENOBIA L. SOWELL
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Credential | DDS
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Telephone | 312-944-9355
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State | IL
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