Provider Demographics
NPI:1023200706
Name:NORTH CHICAGO COMMUNITY HEALTH CENTER
Entity Type:Organization
Organization Name:NORTH CHICAGO COMMUNITY HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF DENTISTRY
Authorized Official - Prefix:DR
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:
Authorized Official - Last Name:DISMER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:847-377-8581
Mailing Address - Street 1:2215 14TH ST
Mailing Address - Street 2:
Mailing Address - City:NORTH CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60064-1618
Mailing Address - Country:US
Mailing Address - Phone:847-984-5230
Mailing Address - Fax:
Practice Address - Street 1:2215 14TH ST
Practice Address - Street 2:
Practice Address - City:NORTH CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60064-1618
Practice Address - Country:US
Practice Address - Phone:847-984-5230
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LAKE COUNTY HEALTH DEPARTMENT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-08-15
Last Update Date:2007-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare