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NPI Code Detail

MEDICARE: FAMILY CARE DENTAL GROUP, LTD.

MEDICARE: FAMILY CARE DENTAL GROUP, 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 Dentistry019018642IL

General Provider Information

NPI Number : 1831490911
Entity Type Code : Organization
Provider Name (Legal Business Name) : FAMILY CARE DENTAL GROUP, LTD.
Provider Business Mailing Address
First Line : 3143 W DEVON AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60659-1424
Country : US
Telephone Number : 773-465-2922
Fax Number : 773-465-2998
Provider Business Practice Location Address
First Line : 3143 W DEVON AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60659-1424
Country : US
Telephone Number : 773-465-2922
Fax Number : 773-465-2998
Authorized Official
Title or Position : DENTIST/OWNER
Name : DR. MARK MKRDICHIAN
Credential : DDS
Telephone Number : 773-465-2922
Provider Enumeration Date : 11/05/2010
Last Update Date : 11/05/2010

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Directions to “FAMILY CARE DENTAL GROUP, LTD. ” Practice Location

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