Healthcare Provider Details

I. General information

NPI: 1992225627
Provider Name (Legal Business Name): SUSAN SUNOK SINGER DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2017
Last Update Date: 06/23/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2632 W DIVISION ST
CHICAGO IL
60622-2850
US

IV. Provider business mailing address

2735 N FRANCISCO AVE APT 2
CHICAGO IL
60647-1700
US

V. Phone/Fax

Practice location:
  • Phone: 872-829-2940
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License Number019.031233
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: