The Wrigleyville Dental Group
Dentist in Chicago, IL. Organization (NPI-2).
NPI number1508023136
StatusActive
Last updated in NPPESMay 21, 2008
Details
- NPI
- 1508023136
- Entity type
- Organization (NPI-2)
- Legal business name
- The Wrigleyville Dental Group
- Organization subpart
- No
- Enumeration date
- May 21, 2008
- Last updated
- May 21, 2008
Medicare and OIG
- Medicare enrolled (PECOS)
- Not in the Medicare enrollment file
- Can order and refer
- Not on the CMS order and referring list
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 122300000X | Dentist | 019019128 | IL | Yes |
Practice location
1353 W Cornelia AveChicago, IL 60657-1401
Phone 773-975-6666 · Fax 773-975-4051
Mailing address
1353 W Cornelia AveChicago, IL 60657-1401
Phone 773-975-6666 · Fax 773-975-4051
Authorized official
John A Benedetto
D.D.S./
7739756666
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