Organization · Type 2 NPI

Edp of Wisconsin, SC

Dental Clinic/Center · Chicago, IL

NPI number 1962961672 Active

Practice location

141 W Jackson Blvd
Chicago, IL 60604-2992

Call (312) 937-3619 Map

Mailing address

141 W Jackson Blvd Ste 210
Chicago, IL 60604-3048

Other practice locations

655 Deerwood Ave, Neenah, WI 54956-1629 · (312) 800-1270

Specialties and licenses

Taxonomy	Code	License
Dental Clinic/Center Primary	261QD0000X	None listed

Dental Clinic/Center: Definition to come...

15 other providers at this address

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NPI record

NPI: 1962961672
Entity type: Organization (Type 2)
Issued: Mar 13, 2019
Last updated: Sep 16, 2019
Status: Active
Subpart: Yes of Edp of Wisconsin, SC

Other names

<unavail>
Elite Dental Partners · doing business as
Parkside West Dental · doing business as

Authorized official

Roseanne Brunenkant
Director of Integrations
(312) 937-3619

Verify this record

This page mirrors the public NPPES file. For credentialing or billing, confirm it on the official CMS NPI Registry, and check the license with the state board.

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About NPI 1962961672

Edp of Wisconsin, SC's National Provider Identifier is 1962961672, issued on Mar 13, 2019. The primary taxonomy on file is Dental Clinic/Center (261QD0000X), and the practice location is in Chicago, IL. The record was last updated on Sep 16, 2019.