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Contact Information

WICKER PARK DENTAL GROUP
LBN WICKER PARK DENTAL, LTD
1738 W NORTH AVE
CHICAGO, IL60622
 Phone: 773-276-5566
 Fax: 773-276-8780
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Dentist

122300000X
 

Dental

261QD0000X
Indicates primary specialty

NPI Profile & details for WICKER PARK DENTAL GROUP

NPI # 1003962192
LBN Legal business name WICKER PARK DENTAL, LTD
DBA Doing business as WICKER PARK DENTAL GROUP
Authorized official NIDZA ALICEA - (OFFICE MANAGER)
Entity Organization
Organization subpart 1 No
Enumeration date 01/25/2007
Last updated 02/09/2009 - About 11 years ago
Identifiers
IL License # 060010054
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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