Old Town Dental Care, P.c.

NPI 1265677314 - Dentist - 122300000X

NPI Details
NPI 1265677314
Enumeration Date 12/03/2008
Last Updated 12/03/2008
Entity Type Healthcare Provider
Active Over 8 years ago
Authorized Information
Name SAM SAM
Position PRESIDENT
Phone (312) 573-0007
Fax (312) 573-0002
Practice Location
1504 N WELLS ST
CHICAGO IL, 60610-1308, US
Phone (312) 573-0007
Fax (312) 573-0002
Business Location
1504 N WELLS ST
CHICAGO IL, 60610-1308, US
Phone (312) 573-0007
Fax (312) 573-0002
Toxanomy
Taxonomy Code 122300000X
License State Illinois
License Number 019024892
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According to our database, Old Town Dental Care, P.c. NPI is 1265677314, taxonomy code is 122300000X and license number is 019024892, license state is located at Illinois. Old Town Dental Care, P.c. physically located at 1504 N Wells St, Chicago IL, 60610-1308. NPI Number 1033115704 has the healthcare provider type.

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1265677314 NPI number is provided on an as is basis without warranty of any kind. 1265677314 is maintained by the National Plan & Provider Enumeration System. The contents of Old Town Dental Care, P.c. are for informational purposes only.