Healthcare Provider Details

I. General information

NPI: 1396734026
Provider Name (Legal Business Name): PROVERBS 3 PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/15/2005
Last Update Date: 09/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2447 W 79TH ST
CHICAGO IL
60652-1734
US

IV. Provider business mailing address

PO BOX 20568
CHICAGO IL
60620-0568
US

V. Phone/Fax

Practice location:
  • Phone: 773-776-1285
  • Fax: 773-776-3171
Mailing address:
  • Phone: 773-776-1285
  • Fax: 773-776-3171

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number019022143
License Number StateIL

VIII. Authorized Official

Name: DR. PATRICIA JAMES
Title or Position: PRESIDENT
Credential:
Phone: 773-776-1285