Healthcare Provider Details

I. General information

NPI: 1275937757
Provider Name (Legal Business Name): GEORGE DAMERJI DDS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/13/2014
Last Update Date: 10/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3939 W FULLERTON AVE
CHICAGO IL
60647-2243
US

IV. Provider business mailing address

3939 W FULLERTON AVE
CHICAGO IL
60647-2243
US

V. Phone/Fax

Practice location:
  • Phone: 773-235-0000
  • Fax: 773-235-0001
Mailing address:
  • Phone: 773-235-0000
  • Fax: 773-235-0001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number019028287
License Number StateIL

VIII. Authorized Official

Name: DR. GEORGE DAMERJI
Title or Position: DENTIST
Credential:
Phone: 773-235-0000