Healthcare Provider Details

I. General information

NPI: 1659884591
Provider Name (Legal Business Name): JOBREN DINGLE DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/14/2017
Last Update Date: 03/18/2026
Certification Date: 03/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3006 N LARAMIE AVE
CHICAGO IL
60641-5010
US

IV. Provider business mailing address

3006 N LARAMIE AVE
CHICAGO IL
60641-5010
US

V. Phone/Fax

Practice location:
  • Phone: 617-725-6771
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number019.035741
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: