MEDICARE: ANITA AFSHARI 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
1	122300000X	Dentist	019032834	IL

General Provider Information

NPI Number	:	1538778477
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANITA AFSHARI DDS

Provider Business Mailing Address
First Line	:	677 W WRIGHTWOOD AVE APT 2E
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60614-2521
Country	:	US
Telephone Number	:	615-517-4742
Fax Number	:

Provider Business Practice Location Address
First Line	:	3425 S KING DR
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60616-4108
Country	:	US
Telephone Number	:	312-313-9777
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/27/2020
Last Update Date	:	07/27/2020

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