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General NPI Number Information
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NPI Number | 1285731208
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Entity Type | Organization
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Legal Business Name | MONTCLARE DENTAL INC
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Dates
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Enumeration Date | 09/20/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 7185 W. GRAND AVE.
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City | CHICAGO
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State | IL
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Zip | 60707
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Country | US
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Telephone | 773-622-1818
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Fax | 773-622-8370
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Provider Business Mailing Address
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Address Line | 7185 W. GRAND AVE.
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City | CHICAGO
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State | IL
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Zip | 60707
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Country | US
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Telephone | 773-622-1818
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Fax | 773-622-8370
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Authorized Official
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Title or Position | OWNER
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Name | DR. ADNAN ATCHA
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Credential | DMD
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Telephone | 773-622-1818
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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 | IL
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