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General NPI Number Information
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NPI Number | 1275443566
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Entity Type | Organization
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Legal Business Name | ALTA ARCHER HEIGHTS
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Dates
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Enumeration Date | 09/09/2026
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Last Update Date | 09/09/2026
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Provider Practice Location Address
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Address Line | 4889 S ARCHER AVE
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City | CHICAGO
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State | IL
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Zip | 60632-3621
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Country | US
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Telephone | 773-295-7600
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Fax |
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Provider Business Mailing Address
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Address Line | 555 W KINZIE ST APT 1007E
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City | CHICAGO
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State | IL
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Zip | 60654-5842
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Country | US
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Telephone | 218-329-2753
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Fax |
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Authorized Official
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Title or Position | OWNER / PARTNER
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Name | CHRIS WORTH
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Credential | DDS
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Telephone | 218-329-2753
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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 |
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License Number State |
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