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NPI Code Detail

MEDICARE: THE DENTAL CLINIC, LLC

MEDICARE: THE DENTAL CLINIC, 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
11223G0001XGeneral Practice DentistryIL

General Provider Information

NPI Number : 1538330527
Entity Type Code : Organization
Provider Name (Legal Business Name) : THE DENTAL CLINIC, LLC
Provider Business Mailing Address
First Line : 3210 W 63RD ST
Second Line :
City : CHICAGO
State : IL
Zip : 60629-3325
Country : US
Telephone Number : 773-776-8300
Fax Number :
Provider Business Practice Location Address
First Line : 3210 W 63RD ST
Second Line :
City : CHICAGO
State : IL
Zip : 60629-3325
Country : US
Telephone Number : 773-776-8300
Fax Number :
Authorized Official
Title or Position : OWNER/DENTIST
Name : SAMEERA HUSSAIN
Credential : DMD
Telephone Number : 630-750-1405
Provider Enumeration Date : 03/18/2008
Last Update Date : 03/18/2008

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Directions to “THE DENTAL CLINIC, LLC ” Practice Location

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