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NPI Code Detail

MEDICARE: IRVING PARK FAMILY DENTIST

MEDICARE: IRVING PARK FAMILY DENTIST
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 Dentistry019024678IL

General Provider Information

NPI Number : 1942595442
Entity Type Code : Organization
Provider Name (Legal Business Name) : IRVING PARK FAMILY DENTIST
Provider Business Mailing Address
First Line : 3435 W IRVING PARK RD
Second Line :
City : CHICAGO
State : IL
Zip : 60618-3217
Country : US
Telephone Number : 773-588-8200
Fax Number : 773-588-8208
Provider Business Practice Location Address
First Line : 3435 W IRVING PARK RD
Second Line :
City : CHICAGO
State : IL
Zip : 60618-3217
Country : US
Telephone Number : 773-588-8200
Fax Number : 773-588-8208
Authorized Official
Title or Position : DIRECTOR OF CORPORATE OPERATIONS
Name : IVANA BUENO
Credential :
Telephone Number : 773-798-9382
Provider Enumeration Date : 06/13/2011
Last Update Date : 10/13/2025

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Practice Location Address:
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60618-3217
Practice Phone: 773-588-8200
Practice Fax: 773-588-8208
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Practice Fax:
1861905028 — ALENA BUKHAR DMD
Practice Location Address:
3435 W IRVING PARK RD
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60618-3217
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1649783440 — HENNA ABBASI
Practice Location Address:
3435 W IRVING PARK RD
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60618-3217
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Directions to “IRVING PARK FAMILY DENTIST ” Practice Location

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