Madison Pine Dental

NPI #1942322664 in Chicago, Illinois

Provider Information

NPI Number: 1942322664
Entity Type: Organization
Organization Name: Madison Pine Dental
Primary Specialty: Dentist - General Practice
Enumeration Date: Apr 4, 2007
Last Updated: Aug 22, 2020

Practice Location

Address: 5470 W MADISON ST
City: Chicago
State: Illinois
ZIP Code: 60644-4031
Phone: (773) 287-3939

Authorized Official

Name: DR. JAMES POULOS
Title: DENTIST
Phone: (773) 287-3939

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist - General Practice — General Practice	1223G0001X	Primary

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