Provider Demographics
NPI:1295143618
Name:SONRISA FAMILY DENTAL ON ASHLAND
Entity type:Organization
Organization Name:SONRISA FAMILY DENTAL ON ASHLAND
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:DR
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 1:5256 S ASHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60609-5838
Mailing Address - Country:US
Mailing Address - Phone:630-730-3233
Mailing Address - Fax:
Practice Address - Street 1:5256 S ASHLAND AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60609-5838
Practice Address - Country:US
Practice Address - Phone:630-730-3233
Practice Address - Fax:773-484-1205
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SONRISA DENTAL PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-07-29
Last Update Date:2014-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental