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General NPI Number Information
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NPI Number | 1508035619
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Entity Type | Organization
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Legal Business Name | INNOVATIVE ENDODONTICS, P.C.
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Dates
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Enumeration Date | 02/22/2008
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Last Update Date | 02/22/2008
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Provider Practice Location Address
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Address Line | 4346 N PULASKI RD # AB
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City | CHICAGO
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State | IL
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Zip | 60641-2156
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Country | US
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Telephone | 773-544-1025
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Fax | 773-649-9282
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Provider Business Mailing Address
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Address Line | 4346 N PULASKI RD # AB
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City | CHICAGO
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State | IL
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Zip | 60641-2156
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. REBECCA S PRESCOTT
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Credential | DDS, MS
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Telephone | 773-544-1025
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number |
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License Number State | IL
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