Provider Demographics
NPI:1548436959
Name:LINCOLN PARK DENTAL CARE LTD
Entity type:Organization
Organization Name:LINCOLN PARK DENTAL CARE LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SEONG
Authorized Official - Middle Name:JU
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:773-404-0101
Mailing Address - Street 1:424 W FULLERTON PKWY
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-2812
Mailing Address - Country:US
Mailing Address - Phone:773-404-0101
Mailing Address - Fax:773-404-1260
Practice Address - Street 1:424 W FULLERTON PKWY
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-2812
Practice Address - Country:US
Practice Address - Phone:773-404-0101
Practice Address - Fax:773-404-1260
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-06
Last Update Date:2008-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190251171223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty