MEDICARE: AG DENTALCARE 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	122300000X	Dentist		IL

General Provider Information

NPI Number	:	1922271717
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AG DENTALCARE LTD

Provider Business Mailing Address
First Line	:	5030 N MARINE DR
Second Line	:	2201
City	:	CHICAGO
State	:	IL
Zip	:	60640-3267
Country	:	US
Telephone Number	:	773-506-2033
Fax Number	:

Provider Business Practice Location Address
First Line	:	1954 W FOSTER AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60640-1033
Country	:	US
Telephone Number	:	773-506-2033
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. ADRIANA GIURGIU
Credential	:	DMD
Telephone Number	:	773-506-2033

Provider Enumeration Date	:	04/11/2008
Last Update Date	:	04/11/2008

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