| NPI | 1003962192 |
|---|---|
| Doing Business As | WICKER PARK DENTAL GROUP |
| Entity Type | Organization |
| Authorized Contact | NIDZA ALICEA Office Manager 773-235-0980 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: IL 060010054) |
| Additional Taxonomies | 261QD0000X Clinic/Center, Dental |
| Enumeration Date | 2007-01-25 |
| Last Update Date | 2009-02-09 |