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General NPI Number Information
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NPI Number | 1720465099
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Entity Type | Organization
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Legal Business Name | UIC COLLEGE OF DENTISTRY
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Dates
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Enumeration Date | 05/06/2015
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Last Update Date | 05/06/2015
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Provider Practice Location Address
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Address Line | 801 S PAULINA ST RESTORATIVE DENTISTRY 202L
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City | CHICAGO
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State | IL
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Zip | 60612-7210
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Country | US
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Telephone | 312-413-2836
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Fax |
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Provider Business Mailing Address
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Address Line | 801 S PAULINA ST RESTORATIVE DENTISTRY 202L
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City | CHICAGO
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State | IL
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Zip | 60612-7210
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Country | US
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Telephone | 312-413-2836
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Fax |
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Authorized Official
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Title or Position | CLINICAL ASSOCIATE PROFESSOR
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Name | DR. COURTNEY C. LAMB
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Credential | DDS
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Telephone | 312-413-2836
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 019019207
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License Number State | IL
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