1437597598 NPI number — DR. CARMEN VILLASANTE GRAVES D.D.S, M.S

Table of content: DR. CARMEN VILLASANTE GRAVES D.D.S, M.S (NPI 1437597598)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437597598 NPI number — DR. CARMEN VILLASANTE GRAVES D.D.S, M.S

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GRAVES
Provider First Name:
CARMEN
Provider Middle Name:
VILLASANTE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.D.S, M.S
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
VILLASANTE MERCADO
Provider Other First Name:
CARMEN
Provider Other Middle Name:
NORA
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1437597598
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/06/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
850 S WABASH AVE STE 240
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:
60605-3643
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
312-356-4700
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
850 S WABASH AVE STE 240
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:
60605-3643
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
312-356-4700
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/11/2013

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223P0300X , with the licence number:  019.031010 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1223P0300X , with the licence number: 32052 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1223P0300X , with the licence number: 22154 , registered in the state of ZZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1223P0300X , with the licence number: 021.002792 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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