MEDICARE: LINCOLN SQUARE 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
1	1223G0001X	General Practice Dentistry		IL

General Provider Information

NPI Number	:	1881768711
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LINCOLN SQUARE DENTAL ASSOCIATES, LTD.

Provider Business Mailing Address
First Line	:	4770 N LINCOLN AVE
Second Line	:	SUITE 12
City	:	CHICAGO
State	:	IL
Zip	:	60625-2092
Country	:	US
Telephone Number	:	773-275-5548
Fax Number	:

Provider Business Practice Location Address
First Line	:	4770 N LINCOLN AVE
Second Line	:	SUITE 12
City	:	CHICAGO
State	:	IL
Zip	:	60625-2092
Country	:	US
Telephone Number	:	773-275-5548
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	NATALIJA SIMOVIC
Credential	:	D.D.S.
Telephone Number	:	773-275-5548

Provider Enumeration Date	:	11/20/2006
Last Update Date	:	08/22/2020

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