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General NPI Number Information
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NPI Number | 1891953972
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Entity Type | Organization
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Legal Business Name | PRECISION DENTAL CARE, LLC
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Dates
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Enumeration Date | 05/27/2008
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 4641 W DIVERSEY AVE
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City | CHICAGO
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State | IL
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Zip | 60639-1828
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Country | US
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Telephone | 772-202-0333
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Fax | 773-202-1333
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Provider Business Mailing Address
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Address Line | 4614 S KEDZIE AVE
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City | CHICAGO
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State | IL
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Zip | 60632-2945
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Country | US
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Telephone | 773-376-8150
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Fax | 773-376-8151
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Authorized Official
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Title or Position | MEMBER
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Name | DR. RANDY CHANG
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Credential | D.D.S.
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Telephone | 773-202-0333
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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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