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General NPI Number Information
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NPI Number | 1992880140
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Entity Type | Organization
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Legal Business Name | ESSENTIAL DENTAL,P.C.
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Dates
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Enumeration Date | 10/26/2006
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 255 E 103RD ST
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City | CHICAGO
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State | IL
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Zip | 60628-2807
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Country | US
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Telephone | 773-468-4554
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Fax | 773-468-4848
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Provider Business Mailing Address
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Address Line | 255 E 103RD ST
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City | CHICAGO
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State | IL
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Zip | 60628-2807
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Country | US
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Telephone | 773-468-4554
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Fax | 773-468-4848
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Authorized Official
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Title or Position | DENTIST
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Name | DR. OPHELIA KAY CARLTON
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Credential | D.D.S.
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Telephone | 773-468-4554
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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 | IL
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