Healthcare Provider Details

I. General information

NPI: 1841319829
Provider Name (Legal Business Name): HARVEY JAY MAHLER D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/28/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 N MICHIGAN AVE SUITE 1608
CHICAGO IL
60602-3402
US

IV. Provider business mailing address

30 N MICHIGAN AVE SUITE 1608
CHICAGO IL
60602-3402
US

V. Phone/Fax

Practice location:
  • Phone: 312-263-5262
  • Fax: 312-263-5280
Mailing address:
  • Phone: 312-263-5262
  • Fax: 312-263-5280

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: