MEDICARE: SANEI CENTER PC

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	019.028529	IL

General Provider Information

NPI Number	:	1952659005
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SANEI CENTER PC

Provider Business Mailing Address
First Line	:	2604 W NORTH AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60647-5235
Country	:	US
Telephone Number	:	773-252-0033
Fax Number	:

Provider Business Practice Location Address
First Line	:	2604 W NORTH AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60647-5235
Country	:	US
Telephone Number	:	773-252-0033
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	BEHZAD SANEI
Credential	:	DMD
Telephone Number	:	773-252-0033

Provider Enumeration Date	:	08/21/2012
Last Update Date	:	08/21/2012

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