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NPI Code Detail

MEDICARE: DEBBIE REDDICK D.D.S.

MEDICARE:   DEBBIE  REDDICK  D.D.S.
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
11223G0001XGeneral Practice DentistryIL

General Provider Information

NPI Number : 1295907749
Entity Type Code : Individual
Provider Name (Legal Business Name) : DEBBIE REDDICK D.D.S.
Provider Business Mailing Address
First Line : 700 S FEDERAL ST
Second Line : 138
City : CHICAGO
State : IL
Zip : 60605-1814
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 700 S FEDERAL ST
Second Line : 138
City : CHICAGO
State : IL
Zip : 60605-1814
Country : US
Telephone Number : 312-431-0366
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/25/2008
Last Update Date : 03/25/2008

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Directions to “ DEBBIE REDDICK D.D.S.” Practice Location

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