1437320652 NPI number — DEVON DENTAL SURGERY, LTD.

Table of content: (NPI 1437320652)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437320652 NPI number — DEVON DENTAL SURGERY, LTD.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DEVON DENTAL SURGERY, LTD.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
CHICAGO ORAL CARE, LTD.
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1437320652
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/03/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1529 W DEVON AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHICAGO
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60660-1313
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
773-761-2521
Provider Business Mailing Address Fax Number:
773-761-2522

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1514 W DEVON AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60660-1314
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
773-761-2521
Provider Business Practice Location Address Fax Number:
773-761-2522
Provider Enumeration Date:
03/15/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
SANAI
Authorized Official First Name:
NINA
Authorized Official Middle Name:
N
Authorized Official Title or Position:
PRESIDENT/ DENTIST
Authorized Official Telephone Number:
773-761-2521

Provider Taxonomy Codes

  • Taxonomy code: 122300000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)