Wicker Park Dental LLC

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

License

019016946 Issued in IL

Legal business name

WICKER PARK DENTAL LLC

Practice address

1738 W North Ave
Chicago, IL 60622-2147

Phone

(773) 276-5566

Fax

(773) 276-8780

NPI assigned

Nov 16, 2010

Last updated

Nov 16, 2010By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Susan Stuart Brown

Title

Office Manager

Phone

(773) 276-5566

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1289865600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1289865600000",
    "number": "1326349770",
    "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": "606222147",
            "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": "606222147",
            "telephone_number": "773-276-5566",
            "fax_number": "773-276-8780"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WICKER PARK DENTAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-11-16",
        "last_updated": "2010-11-16",
        "status": "A",
        "authorized_official_last_name": "BROWN",
        "authorized_official_first_name": "SUSAN",
        "authorized_official_middle_name": "STUART",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "773-276-5566"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "IL",
            "license": "019016946",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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

• Dental Clinic/Center in Chicago, IL
• Providers in Chicago, IL by specialty
• Dental Clinic/Center in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 16, 2010; 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.