MEDICARE: BEYOND THE SKYLINE LLC

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	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1326630690
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BEYOND THE SKYLINE LLC

Provider Business Mailing Address
First Line	:	565 W QUINCY ST UNIT 1506
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60661-2911
Country	:	US
Telephone Number	:	218-329-2753
Fax Number	:

Provider Business Practice Location Address
First Line	:	2156 N DAMEN AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60647-6481
Country	:	US
Telephone Number	:	218-329-2753
Fax Number	:

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	DR. CHRIS WORTH
Credential	:	DDS
Telephone Number	:	218-329-2753

Provider Enumeration Date	:	02/09/2021
Last Update Date	:	02/09/2021

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Directions to “BEYOND THE SKYLINE LLC ” Practice Location

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