Provider Demographics
NPI:1437564754
Name:SONRISA DENTAL CHICAGO HEIGHTS
Entity Type:Organization
Organization Name:SONRISA DENTAL CHICAGO HEIGHTS
Other - Org Name:SONRISA DENTAL CHICAGO HEIGHTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:LUKASZCZYK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-730-3233
Mailing Address - Street 1:1415 EMERALD AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60411-3517
Mailing Address - Country:US
Mailing Address - Phone:708-756-7384
Mailing Address - Fax:
Practice Address - Street 1:1415 EMERALD AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60411-3517
Practice Address - Country:US
Practice Address - Phone:708-756-7384
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SONRISA DENTAL PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-06-25
Last Update Date:2014-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental