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General NPI Number Information
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NPI Number | 1801298856
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Entity Type | Organization
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Legal Business Name | CUSHING DENTAL, P.C.
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Dates
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Enumeration Date | 09/22/2014
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Last Update Date | 09/22/2014
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Provider Practice Location Address
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Address Line | 2859 N HALSTED ST #1
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City | CHICAGO
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State | IL
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Zip | 60657-7009
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Country | US
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Telephone | 773-248-8836
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Fax |
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Provider Business Mailing Address
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Address Line | 2859 N HALSTED ST #1
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City | CHICAGO
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State | IL
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Zip | 60657-7009
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Country | US
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Telephone | 773-248-8836
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | JAIME CUSHING
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Credential | D.D.S.
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Telephone | 773-248-8836
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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 | 019.027354
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License Number State | IL
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