MEDICARE: DENTAL TOWN LTD

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

General Provider Information

NPI Number	:	1295204220
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DENTAL TOWN LTD

Provider Business Mailing Address
First Line	:	3004 W 26TH ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60623-4128
Country	:	US
Telephone Number	:	773-231-8000
Fax Number	:

Provider Business Practice Location Address
First Line	:	3004 W 26TH ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60623-4128
Country	:	US
Telephone Number	:	773-231-8000
Fax Number	:	773-231-8000

Authorized Official
Title or Position	:	VP OF OPERATIONS
Name	:	SAMANTHA GONZALEZ
Credential	:
Telephone Number	:	708-713-5000

Provider Enumeration Date	:	11/20/2018
Last Update Date	:	12/08/2025

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Directions to “DENTAL TOWN LTD ” Practice Location

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