Healthcare Provider Details

I. General information

NPI: 1528127537
Provider Name (Legal Business Name): THIRTY NORTH ENDODONTICS LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2006
Last Update Date: 07/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 N MICHIGAN AVENUE #1320
CHICAGO IL
60602
US

IV. Provider business mailing address

30 N MICHIGAN AVENUE #1320
CHICAGO IL
60602
US

V. Phone/Fax

Practice location:
  • Phone: 312-236-6077
  • Fax: 312-236-7985
Mailing address:
  • Phone: 312-236-6077
  • Fax: 312-236-7985

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number
License Number State

VIII. Authorized Official

Name: DR. CHARLES R NEACH
Title or Position: PRESIDENT OWNER
Credential: DDS
Phone: 312-236-6077