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NPI Code Detail

MEDICARE: CHICAGO PEDIATRIC DENTISTRY AND ORTHODONTICS PLLC

MEDICARE: CHICAGO PEDIATRIC DENTISTRY AND ORTHODONTICS PLLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QD0000XDental Clinic/Center
21223X0400XOrthodontics and Dentofacial Orthopedics Dentistry
31223P0221XPediatric Dentistry

General Provider Information

NPI Number : 1124629514
Entity Type Code : Organization
Provider Name (Legal Business Name) : CHICAGO PEDIATRIC DENTISTRY AND ORTHODONTICS PLLC
Provider Business Mailing Address
First Line : 1136 S DELANO CT W STE B202
Second Line :
City : CHICAGO
State : IL
Zip : 60605-3734
Country : US
Telephone Number : 312-437-0593
Fax Number :
Provider Business Practice Location Address
First Line : 1136 S DELANO CT W STE B202
Second Line :
City : CHICAGO
State : IL
Zip : 60605-3734
Country : US
Telephone Number : 312-766-0995
Fax Number :
Authorized Official
Title or Position : OWNER
Name : DR. JUSTIN WELKE
Credential : DDS
Telephone Number : 630-886-1780
Provider Enumeration Date : 11/03/2020
Last Update Date : 06/30/2026

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Directions to “CHICAGO PEDIATRIC DENTISTRY AND ORTHODONTICS PLLC ” Practice Location

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