Provider Demographics
NPI:1083841449
Name:FAMILY DENTAL ENTER CHICAGO
Entity Type:Organization
Organization Name:FAMILY DENTAL ENTER CHICAGO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:NELI
Authorized Official - Middle Name:
Authorized Official - Last Name:TUJAROVA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-262-4242
Mailing Address - Street 1:2710 W DEVON AVE. 3RD FLOOR
Mailing Address - Street 2:
Mailing Address - City:WHEELING
Mailing Address - State:IL
Mailing Address - Zip Code:60090
Mailing Address - Country:US
Mailing Address - Phone:773-262-4242
Mailing Address - Fax:773-262-4343
Practice Address - Street 1:2710 W DEVON AVE. 3RD FLOOR
Practice Address - Street 2:
Practice Address - City:WHEELING
Practice Address - State:IL
Practice Address - Zip Code:60090
Practice Address - Country:US
Practice Address - Phone:773-262-4242
Practice Address - Fax:773-262-4343
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-12
Last Update Date:2009-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental