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General NPI Number Information
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NPI Number | 1255515391
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Entity Type | Organization
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Legal Business Name | DENTAL CORPORATE USA
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Dates
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Enumeration Date | 12/26/2007
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Last Update Date | 07/12/2023
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Provider Practice Location Address
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Address Line | 5333 N CLARK ST
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City | CHICAGO
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State | IL
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Zip | 60640-2121
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Country | US
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Telephone | 773-728-5333
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Fax | 773-739-4300
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Provider Business Mailing Address
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Address Line | 5333 N CLARK ST
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City | CHICAGO
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State | IL
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Zip | 60640-2121
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Country | US
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Telephone | 773-728-5333
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Fax | 773-739-4300
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Authorized Official
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Title or Position | GENERAL MANAGER
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Name | MRS. VESNA BELKIC
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Credential |
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Telephone | 630-433-4962
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 019023616
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License Number State | IL
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