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NPI Code Detail

MEDICARE: WEST LOOP DENTAL ASSOCIATES, LTD.

MEDICARE: WEST LOOP DENTAL ASSOCIATES, 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
11223G0001XGeneral Practice DentistryIL

General Provider Information

NPI Number : 1538203989
Entity Type Code : Organization
Provider Name (Legal Business Name) : WEST LOOP DENTAL ASSOCIATES, LTD.
Provider Business Mailing Address
First Line : 1111 W MADISON ST
Second Line : SUITE 1
City : CHICAGO
State : IL
Zip : 60607-2092
Country : US
Telephone Number : 312-666-5166
Fax Number :
Provider Business Practice Location Address
First Line : 1111 W MADISON ST
Second Line : SUITE 1
City : CHICAGO
State : IL
Zip : 60607-2092
Country : US
Telephone Number : 312-666-5166
Fax Number :
Authorized Official
Title or Position : OWNER
Name : DR. RICHARD J COOPER
Credential : D.D.S.
Telephone Number : 312-666-5166
Provider Enumeration Date : 02/19/2007
Last Update Date : 09/07/2007

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Directions to “WEST LOOP DENTAL ASSOCIATES, LTD. ” Practice Location

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