MEDICARE: DR. EMILY DRAHOS 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	1223G0001X	General Practice Dentistry	19025628	IL

General Provider Information

NPI Number	:	1598720856
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EMILY DRAHOS DDS

Provider Business Mailing Address
First Line	:	6800 W ARCHER AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60638-2312
Country	:	US
Telephone Number	:	773-788-1001
Fax Number	:	773-788-1388

Provider Business Practice Location Address
First Line	:	6800 W ARCHER AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60638-2312
Country	:	US
Telephone Number	:	773-788-1001
Fax Number	:	773-788-1388

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

Provider Enumeration Date	:	04/19/2006
Last Update Date	:	07/08/2007

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