Healthcare Provider Details

I. General information

NPI: 1447248877
Provider Name (Legal Business Name): ROGER NOUNEH DMD. MS.MBA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2005
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1254 N WELLS ST
CHICAGO IL
60610-1981
US

IV. Provider business mailing address

1254 N WELLS ST
CHICAGO IL
60610-1981
US

V. Phone/Fax

Practice location:
  • Phone: 312-337-3300
  • Fax:
Mailing address:
  • Phone: 312-927-8882
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number021-01990
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number19-025485
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: