Provider Demographics
NPI:1982019204
Name:SONRISA DENTAL LITTLE VILLAGE 26TH
Entity Type:Organization
Organization Name:SONRISA DENTAL LITTLE VILLAGE 26TH
Other - Org Name:SONRISA DENTAL LITTLE VILLAGE 26TH
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 1:3059 SOUTH 26TH STREET
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60623
Mailing Address - Country:US
Mailing Address - Phone:773-247-7600
Mailing Address - Fax:
Practice Address - Street 1:3059 S 26TH ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60623
Practice Address - Country:US
Practice Address - Phone:773-247-7600
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