Healthcare Provider Details

I. General information

NPI: 1205753639
Provider Name (Legal Business Name): FAITH LAUREN DEVENGENCIE DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2026
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3009 E 92ND ST
CHICAGO IL
60617-4598
US

IV. Provider business mailing address

2933 N SHERIDAN RD APT 1210
CHICAGO IL
60657-5947
US

V. Phone/Fax

Practice location:
  • Phone: 773-978-1231
  • Fax:
Mailing address:
  • Phone: 440-309-6778
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number019.037227
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: