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General NPI Number Information
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NPI Number | 1942595442
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Entity Type | Organization
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Legal Business Name | IRVING PARK FAMILY DENTIST
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Dates
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Enumeration Date | 06/13/2011
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Last Update Date | 10/13/2025
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Provider Practice Location Address
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Address Line | 3435 W IRVING PARK RD
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City | CHICAGO
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State | IL
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Zip | 60618-3217
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Country | US
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Telephone | 773-588-8200
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Fax | 773-588-8208
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Provider Business Mailing Address
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Address Line | 3435 W IRVING PARK RD
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City | CHICAGO
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State | IL
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Zip | 60618-3217
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Country | US
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Telephone | 773-588-8200
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Fax | 773-588-8208
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Authorized Official
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Title or Position | DIRECTOR OF CORPORATE OPERATIONS
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Name | IVANA BUENO
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Credential |
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Telephone | 773-798-9382
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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 | 019024678
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License Number State | IL
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