LOGAN SQUARE DENTAL SERVICE CENTER (NPI# 1508038027) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1508038027 |
| Entity Type | Organization |
| Organization Name | LOGAN SQUARE DENTAL SERVICE CENTER |
| Other Organization Name | CICERO IRVING PARK DENTAL GROUP |
| Practice Address |
3946 N Cicero Ave Chicago IL 60641-2711 |
| Practice Telephone | 7732834838 |
| Practice Fax Number | 7732834389 |
| Mailing Telephone | 7732834838 |
| Mailing Fax Number | 7732834389 |
| Enumeration Date | 2008-03-25 |
| Last Update Date | 2008-03-25 |
| Authorized Official Name | DR. WILLIAM LI (PRESIDENT) |
| Authorized Official Telephone | 8472840410 |
| Authorized Official Credential | D.D.S. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QD0000X |
Clinic/Center Specialization: Dental |
IL | Ambulatory Health Care Facilities |
| Other Name | Type Code |
|---|---|
| Cicero Irving Park Dental Group | Doing Business As Name - Organization |
| Street Address |
3946 N CICERO AVE |
| City | CHICAGO |
| State | IL |
| Zip Code | 60641-2711 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1063038131 | Victoria Carmen Grau Kazmierzcak | Student in an Organized Health Care Education/Training Program | 5458 W Grace St, Unit 2, Chicago, IL 60641 | 2020-06-24 |
| 1659926921 | Farah Alhaidar | Counselor | 4028 W Irving Park Rd Loft B, Chicago, IL 60641 | 2019-08-05 |
| 1255898482 | Bernadeta Agnieszka Kapustka | Nurse Practitioner | 5425 W Addison, Chicago, IL 60641 | 2019-02-24 |
| 1295200921 | The Dental Masters of Belmont, LLC | Dentist | 5236 W. Belmont Ave., Chicago, IL 60641 | 2018-10-09 |
| 1700364171 | National Vision Inc | Technician/Technologist | 4068 North Milwaukee Avenue, Chicago, IL 60641 | 2018-07-30 |
| 1477055168 | Elaine Vozar Acupuncturist Ltd | Acupuncturist | 3817 N. Pulaski, Chicago, IL 60641 | 2018-03-08 |
| 1174906853 | Heather Rocco | Hearing Instrument Specialist | 4122 N Millwaukee Ave, Chicago, IL 60641 | 2015-06-30 |
| 1770910184 | Kendra Manning | Physician Assistant | 4959 W. Belmont Ave, Chicago, IL 60641 | 2013-09-30 |
| 1679916274 | Don E Mccree | Technician, Cardiology | 2936 N. Kolmar, 3c, Chicago, IL 60641 | 2013-04-12 |
| 1053664888 | Scott P Dusenbery | Occupational Therapist | 3235 N Lockwood Apt 3, Chicago, IL 60641 | 2012-10-17 |
| Find all providers in zip 60641 | ||||
| Taxonomy Code | 261QD0000X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Dental |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1124629514 | Chicago Pediatric Dentistry and Orthodontics | Clinic/Center | 1136 S Delano Ct W Ste B202, Chicago, IL 60605-3734 | 2020-11-03 |
| 1245858695 | Versiani Dental PC | Clinic/Center | 2340 N California Ave, Chicago, IL 60647-6622 | 2020-07-13 |
| 1710513478 | Ethicadent | Clinic/Center | 6418 W Belmont Ave Ste 101, Chicago, IL 60634-4099 | 2020-03-13 |
| 1558993758 | King Dental, PC | Clinic/Center | 3425 S King Dr, Chicago, IL 60616 | 2020-02-06 |
| 1750912671 | Wicker Park Dental Studio | Clinic/Center | 1282 N Milwaukee Ave, Chicago, IL 60622-9319 | 2020-01-29 |
| 1811535404 | Secure Dental Vi | Clinic/Center | 3540 N Ashland Ave, Chicago, IL 60657-1314 | 2019-12-15 |
| 1154972768 | David K Mayes D.d.s L.t.d. | Clinic/Center | 9101 S Western Ave # 2ndfl, Chicago, IL 60643-6751 | 2019-09-25 |
| 1235787730 | Alta Dental LLC | Clinic/Center | 5892 S Archer Ave, Chicago, IL 60638-1658 | 2019-08-28 |
| 1982257218 | Allure Dental Lincoln Park | Clinic/Center | 558 W Diversey Pkwy, Chicago, IL 60614-1678 | 2019-07-16 |
| 1568026656 | Cjn Loop Dental Ltd | Clinic/Center | 30 N Michigan Ave Ste 622, Chicago, IL 60602-3821 | 2019-04-24 |
| Find all providers in CHICAGO | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.