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General NPI Number Information
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NPI Number | 1760793129
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Entity Type | Organization
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Legal Business Name | DENTAL CARE ASSOCIATES
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Dates
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Enumeration Date | 06/30/2010
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Last Update Date | 06/30/2010
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Provider Practice Location Address
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Address Line | 4332 N ELSTON AVE
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City | CHICAGO
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State | IL
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Zip | 60641-2144
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Country | US
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Telephone | 773-754-3500
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Fax | 630-339-5803
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Provider Business Mailing Address
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Address Line | 4332 N ELSTON AVE
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City | CHICAGO
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State | IL
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Zip | 60641-2144
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Country | US
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Telephone | 773-754-3500
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Fax | 630-339-5803
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. MIRZA BAIG
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Credential |
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Telephone | 773-754-3500
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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 |
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License Number State |
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