Healthcare Provider Details

I. General information

NPI: 1396372777
Provider Name (Legal Business Name): EVANTHIA NICOLE VRANAS DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/25/2020
Last Update Date: 07/28/2021
Certification Date: 07/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 N WABASH AVE STE 1921
CHICAGO IL
60602-2970
US

IV. Provider business mailing address

111 N WABASH AVE STE 1921
CHICAGO IL
60602-2970
US

V. Phone/Fax

Practice location:
  • Phone: 312-332-4424
  • Fax:
Mailing address:
  • Phone: 312-332-4424
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number019.032653
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number019.032653
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: