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General NPI Number Information
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NPI Number | 1699868364
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Entity Type | Organization
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Legal Business Name | CHICAGO OSTEOPATHIC HOSPITAL DENTAL CLINIC, P.C.
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Dates
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Enumeration Date | 10/02/2006
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Last Update Date | 06/11/2008
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Provider Practice Location Address
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Address Line | 1525 E. 53RD ST. #522
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City | CHICAGO
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State | IL
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Zip | 60615-4530
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Country | US
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Telephone | 773-947-4665
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Fax | 773-256-2373
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Provider Business Mailing Address
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Address Line | 1525 E. 53RD ST. #522
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City | CHICAGO
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State | IL
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Zip | 60615-4530
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Country | US
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Telephone | 773-947-4665
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Fax | 773-256-2373
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MS. ANA C HERNANDEZ
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Credential |
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Telephone | 773-947-4665
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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 | 019022626
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License Number State | IL
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