MEDICARE: AESTHETIC DENTAL SOLUTIONS, P.C.

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
1	1223G0001X	General Practice Dentistry	019025718	IL

General Provider Information

NPI Number	:	1144536921
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AESTHETIC DENTAL SOLUTIONS, P.C.

Provider Business Mailing Address
First Line	:	55 E WASHINGTON ST STE 3206
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60602-2248
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	55 E WASHINGTON ST STE 3206
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60602-2248
Country	:	US
Telephone Number	:	312-368-8444
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. NAOKO FUKUSHIMA
Credential	:	D.D.S.
Telephone Number	:	312-368-8444

Provider Enumeration Date	:	08/31/2010
Last Update Date	:	08/31/2010

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