Healthcare Provider Details

I. General information

NPI: 1952188419
Provider Name (Legal Business Name): PATRICIA BEZANIS DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/08/2023
Last Update Date: 11/13/2023
Certification Date: 11/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3009 E 92ND ST
CHICAGO IL
60617-4598
US

IV. Provider business mailing address

3009 E 92ND ST
CHICAGO IL
60617-4598
US

V. Phone/Fax

Practice location:
  • Phone: 773-295-2521
  • Fax:
Mailing address:
  • Phone: 773-295-2521
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number019.034210
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: