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NPI Code Detail

MEDICARE: ANDREA NICHOLE SIDLE DDS

MEDICARE:   ANDREA NICHOLE SIDLE  DDS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1122300000XDentist2009013187MO
2122300000XDentist019029657IL

General Provider Information

NPI Number : 1427383363
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANDREA NICHOLE SIDLE DDS
Provider Business Mailing Address
First Line : 3435 W IRVING PARK RD
Second Line :
City : CHICAGO
State : IL
Zip : 60618-3217
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3435 W IRVING PARK RD
Second Line :
City : CHICAGO
State : IL
Zip : 60618-3217
Country : US
Telephone Number : 773-588-8200
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/09/2009
Last Update Date : 11/06/2019

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Directions to “ ANDREA NICHOLE SIDLE DDS” Practice Location

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