Provider Demographics
NPI:1558413583
Name:BETSY H. ENRIQUEZ DENTAL SERVICES, LTD.
Entity Type:Organization
Organization Name:BETSY H. ENRIQUEZ DENTAL SERVICES, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:BETSY
Authorized Official - Middle Name:HELEN
Authorized Official - Last Name:ENRIQUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:773-247-3800
Mailing Address - Street 1:736 W 35TH ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60616-4484
Mailing Address - Country:US
Mailing Address - Phone:773-247-3800
Mailing Address - Fax:847-720-4757
Practice Address - Street 1:736 W 35TH ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60616-4484
Practice Address - Country:US
Practice Address - Phone:773-247-3800
Practice Address - Fax:847-720-4757
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BETSY H. ENRIQUEZ D.D.S.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-01-18
Last Update Date:2008-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL19A-147371223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL19A-14737OtherLICENSE