Healthcare Provider Details

I. General information

NPI: 1598800096
Provider Name (Legal Business Name): JEANNIE MOSKIN DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5131 N LINCOLN AVE
CHICAGO IL
60625-2585
US

IV. Provider business mailing address

5131 N LINCOLN AVE P.O. BOX 257353
CHICAGO IL
60625-2585
US

V. Phone/Fax

Practice location:
  • Phone: 773-271-5596
  • Fax: 773-271-7842
Mailing address:
  • Phone: 773-271-5596
  • Fax: 773-271-7842

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: