MEDICARE: HC DMD INC

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	019025756	IL

General Provider Information

NPI Number	:	1972794964
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HC DMD INC

Provider Business Mailing Address
First Line	:	2455 DEAN ST
Second Line	:	SUITE D
City	:	ST CHARLES
State	:	IL
Zip	:	60175-4830
Country	:	US
Telephone Number	:	630-377-3630
Fax Number	:

Provider Business Practice Location Address
First Line	:	2455 DEAN ST
Second Line	:	SUITE D
City	:	ST CHARLES
State	:	IL
Zip	:	60175-4830
Country	:	US
Telephone Number	:	630-377-3630
Fax Number	:

Authorized Official
Title or Position	:	DMD
Name	:	HELEN CHAN
Credential	:
Telephone Number	:	847-708-1313

Provider Enumeration Date	:	08/06/2007
Last Update Date	:	10/11/2008

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