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General NPI Number Information
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NPI Number | 1265395917
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Entity Type | Organization
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Legal Business Name | DENTAL TOWN
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Dates
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Enumeration Date | 12/08/2025
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Last Update Date | 12/08/2025
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Provider Practice Location Address
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Address Line | 6283 S ARCHER AVE
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City | CHICAGO
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State | IL
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Zip | 60638-2505
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Country | US
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Telephone | 708-416-8000
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Fax |
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Provider Business Mailing Address
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Address Line | 6283 S ARCHER AVE
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City | CHICAGO
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State | IL
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Zip | 60638-2505
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Country | US
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Telephone | 708-416-8000
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Fax |
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Authorized Official
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Title or Position | VP OF OPERATIONS
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Name | SAMANTHA GONZALEZ
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Credential |
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Telephone | 708-713-5000
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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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