Provider Demographics
NPI:1497066856
Name:ENGLEWOOD DENTAL CARE
Entity Type:Organization
Organization Name:ENGLEWOOD DENTAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MIRZA
Authorized Official - Middle Name:
Authorized Official - Last Name:BAIG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-244-4800
Mailing Address - Street 1:4332 N ELSTON AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60641-2144
Mailing Address - Country:US
Mailing Address - Phone:773-754-3500
Mailing Address - Fax:773-754-3504
Practice Address - Street 1:7114 S VINCENNES AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60621-3506
Practice Address - Country:US
Practice Address - Phone:773-244-4800
Practice Address - Fax:773-244-4807
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-30
Last Update Date:2010-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty