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General NPI Number Information
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NPI Number | 1790592376
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Entity Type | Organization
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Legal Business Name | UNITED DENTAL & BRACES CORP
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Dates
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Enumeration Date | 12/17/2024
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Last Update Date | 03/03/2025
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Provider Practice Location Address
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Address Line | 585 N YORK ST
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City | ELMHURST
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State | IL
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Zip | 60126-1903
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Country | US
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Telephone | 773-499-9385
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Fax |
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Provider Business Mailing Address
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Address Line | 585 N YORK ST
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City | ELMHURST
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State | IL
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Zip | 60126-1903
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Country | US
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Telephone | 773-499-9385
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Fax |
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Authorized Official
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Title or Position | OWNER/DENTIST
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Name | JERMIN M JOSEPH
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Credential | DMD
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Telephone | 773-499-9385
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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 |
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