NPI 1033465711

North Clark Dental

Organisation Preferred Provider Organization Chicago, IL

Practice location

Address: 6339 N Clark St, Chicago, IL 60660
Phone: (773) 262-8393
Fax: (773) 262-5896

Authorised official

Name: Victor W Tomasian
Title: President
Phone: (773) 262-8393

Registered specialties

Preferred Provider Organization Primary

Managed Care Organizations Taxonomy 305R00000X Licence 019022349 (IL)

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Registry record

NPI: 1033465711
Entity type: Organization
NPI issued: 31 Jul 2012
Record last updated: 31 Jul 2012

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.