MEDICARE: EC CARE DENTAL CENTER,INC.

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	122300000X	Dentist	019027077	IL

General Provider Information

NPI Number	:	1427479963
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EC CARE DENTAL CENTER,INC.

Provider Business Mailing Address
First Line	:	3334 W PETERSON AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60659-3505
Country	:	US
Telephone Number	:	773-539-3559
Fax Number	:	773-539-3569

Provider Business Practice Location Address
First Line	:	3334 W PETERSON AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60659-3505
Country	:	US
Telephone Number	:	773-539-3559
Fax Number	:	773-539-3569

Authorized Official
Title or Position	:	DDS
Name	:	ERLA A. CALDERON
Credential	:
Telephone Number	:	773-539-3559

Provider Enumeration Date	:	12/31/2013
Last Update Date	:	12/31/2013

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