Healthcare Provider Details

I. General information

NPI: 1285502229
Provider Name (Legal Business Name): COUNTING TEETH ANESTHESIA PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/29/2025
Last Update Date: 10/29/2025
Certification Date: 10/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1345 S WABASH AVE UNIT 405
CHICAGO IL
60605-2575
US

IV. Provider business mailing address

1345 S WABASH AVE UNIT 405
CHICAGO IL
60605-2575
US

V. Phone/Fax

Practice location:
  • Phone: 773-217-0097
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223D0004X
TaxonomyDental Anesthesiology
License Number
License Number State

VIII. Authorized Official

Name: SUE CHUNG
Title or Position: MEMBER
Credential: DDS
Phone: 505-463-7934