MEDICARE: SANDRIK DENTAL 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
1	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1801001177
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SANDRIK DENTAL LTD.

Provider Business Mailing Address
First Line	:	6234 S NARRAGANSETT AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60638-4233
Country	:	US
Telephone Number	:	773-586-3456
Fax Number	:	773-586-1277

Provider Business Practice Location Address
First Line	:	6234 S NARRAGANSETT AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60638-4233
Country	:	US
Telephone Number	:	773-586-3456
Fax Number	:	773-586-1277

Authorized Official
Title or Position	:	DENTIST
Name	:	DR. MARK R SANDRIK
Credential	:	DDS
Telephone Number	:	773-586-3456

Provider Enumeration Date	:	05/11/2007
Last Update Date	:	08/22/2020

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