Provider Demographics
NPI:1740522200
Name:ECO FRIENDLY DENTISTRY PC
Entity type:Organization
Organization Name:ECO FRIENDLY DENTISTRY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACCESS MANAGER
Authorized Official - Prefix:MISS
Authorized Official - First Name:GLORIA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAVEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-429-1400
Mailing Address - Street 1:4934 W 95TH ST
Mailing Address - Street 2:
Mailing Address - City:OAK LAWN
Mailing Address - State:IL
Mailing Address - Zip Code:60453-2504
Mailing Address - Country:US
Mailing Address - Phone:773-429-1400
Mailing Address - Fax:630-596-9411
Practice Address - Street 1:4934 W 95TH ST
Practice Address - Street 2:
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-2504
Practice Address - Country:US
Practice Address - Phone:773-429-1400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-22
Last Update Date:2021-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL3190279551223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty