Wicker Park Dental, LTD

Primary specialty

DentistTaxonomy code 122300000X

License

060010054 Issued in IL

Legal business name

WICKER PARK DENTAL, LTD

Doing business as

Wicker Park Dental Group

Practice address

1738 W North Ave
Chicago, IL 60622

Phone

(773) 276-5566

Fax

(773) 276-8780

NPI assigned

Jan 25, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Nidza Alicea

Title

Office Manager

Phone

(773) 235-0980

Specialties & licenses 2

Addresses

Other names 1

• Wicker Park Dental Group Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1169683200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1234137600000",
    "number": "1003962192",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1738 W. NORTH AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "60622",
            "telephone_number": "773-276-5566",
            "fax_number": "773-276-8780"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1738 W NORTH AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "60622",
            "telephone_number": "773-276-5566",
            "fax_number": "773-276-8780"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WICKER PARK DENTAL, LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-25",
        "last_updated": "2009-02-09",
        "status": "A",
        "authorized_official_last_name": "ALICEA",
        "authorized_official_first_name": "NIDZA",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "773-235-0980"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "IL",
            "license": "060010054",
            "primary": true
        },
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Wicker Park Dental Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• David Thomas Wick, MA
• Rachel Wick, MD
• Erin Wickens, MS, RDN
• Wicker Park Chiropractic Health
• Wicker Park Dental LLC
• Wicker Park Eye Center LTD
• Wicker Park Heart Specialists, LLC
• Wicker Park Orthodontia, LTD. (Wicker Park Orthodontics)
• Wicker Park Renaissance
• Wicker Park Spine and Stability, LLC

• Dentist in Chicago, IL
• Providers in Chicago, IL by specialty
• Dentist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 9, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.