MEDICARE: PRECISION DENTAL CARE, 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
1	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1891953972
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRECISION DENTAL CARE, LLC

Provider Business Mailing Address
First Line	:	4614 S KEDZIE AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60632-2945
Country	:	US
Telephone Number	:	773-376-8150
Fax Number	:	773-376-8151

Provider Business Practice Location Address
First Line	:	4641 W DIVERSEY AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60639-1828
Country	:	US
Telephone Number	:	772-202-0333
Fax Number	:	773-202-1333

Authorized Official
Title or Position	:	MEMBER
Name	:	DR. RANDY CHANG
Credential	:	D.D.S.
Telephone Number	:	773-202-0333

Provider Enumeration Date	:	05/27/2008
Last Update Date	:	07/21/2022

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