Organization · NPI-2

105 W Madison Dental PC

Dentist · Chicago, IL

NPI number1730674227
StatusActive
Last updated in NPPESJun 27, 2018

Details

NPI
1730674227
Entity type
Organization (NPI-2)
Legal business name
105 W Madison Dental PC
Organization subpart
No
Enumeration date
Jun 27, 2018
Last updated
Jun 27, 2018

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
122300000X Dentist––Yes

Practice location

105 W Madison St Ste 300
Chicago, IL 60602-4602

Phone 561-899-4595

Mailing address

600 Fairway Dr Ste 206
Deerfield Beach, FL 33441-1807

Phone 561-899-4595

Authorized official

Timothy Skidmore
Practice Administrator
6308169064

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