Organization · NPI-2

1st Family Dental Of Pulaski PC

Dentist · Chicago, IL

NPI number1104364769
StatusActive
Last updated in NPPESFeb 3, 2017

Details

NPI
1104364769
Entity type
Organization (NPI-2)
Legal business name
1st Family Dental Of Pulaski PC
Organization subpart
No
Enumeration date
Feb 3, 2017
Last updated
Feb 3, 2017

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
122300000X Dentist019023616ILYes

Practice location

4707 N Pulaski Rd
Chicago, IL 60630-4312

Phone 773-279-9977

Mailing address

4901 N Kedzie Ave
Chicago, IL 60625-5009

Phone 773-340-8318

Authorized official

Vesna Belkic
Coo
7733408318

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