MEDICARE: BRIDGEPORT DENTAL SMILES 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	122300000X	Dentist

General Provider Information

NPI Number	:	1518425636
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRIDGEPORT DENTAL SMILES LLC

Provider Business Mailing Address
First Line	:	3014 S HALSTED ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60608-5805
Country	:	US
Telephone Number	:	219-465-8627
Fax Number	:

Provider Business Practice Location Address
First Line	:	3014 S HALSTED ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60608-5805
Country	:	US
Telephone Number	:	219-465-8627
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR OF OPERATIONS
Name	:	OSCAR G GONZALEZ
Credential	:
Telephone Number	:	219-465-8627

Provider Enumeration Date	:	03/07/2019
Last Update Date	:	03/07/2019

Similar Medicare Providers

1487638920 — DR. SHELDON LO DPT, MS, ATC
Practice Location Address:

3008 S HALSTED ST , SUITE 116
CHICAGO, IL
60608-5805

Practice Phone: 312-842-1205
Practice Fax: 312-842-1356

1891701330 — WALGREEN CO
Practice Location Address:

3000 S HALSTED ST
CHICAGO, IL
60608-5805

Practice Phone: 312-225-0537
Practice Fax: 312-225-1015

1356668586 — ATHLETIC AND THERAPEUTIC INSTITUTE OF NAPERVILLE, LLC
Practice Location Address:

3008 S HALSTED ST , SUITE 116
CHICAGO, IL
60608-5805

Practice Phone: 312-842-1205
Practice Fax: 312-842-1356

1609159771 — CAROLYN LIGUE
Practice Location Address:

3000 S HALSTED ST
CHICAGO, IL
60608-5805

Practice Phone: 312-225-0537
Practice Fax: 312-225-1015

1528487220 — BRIDGEPORT SMILES
Practice Location Address:

3014 S HALSTED ST
CHICAGO, IL
60608-5805

Practice Phone: 312-291-9283
Practice Fax:

1669891800 — ANDREW MOY PT
Practice Location Address:

3008 S HALSTED ST , SUITE 116
CHICAGO, IL
60608-5805

Practice Phone: 312-842-1205
Practice Fax: 312-842-1356

1609229046 — KWONG LAM PTA
Practice Location Address:

3008 S HALSTED ST , SUITE 116
CHICAGO, IL
60608-5805

Practice Phone: 312-842-1205
Practice Fax: 312-842-1356

Directions to “BRIDGEPORT DENTAL SMILES LLC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.