Healthcare Provider Details

I. General information

NPI: 1982665204
Provider Name (Legal Business Name): REZA SANAI DDS, MS
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1514 W DEVON AVE
CHICAGO IL
60660-1314
US

IV. Provider business mailing address

1514 W DEVON AVE
CHICAGO IL
60660-1314
US

V. Phone/Fax

Practice location:
  • Phone: 773-761-2521
  • Fax: 773-761-2522
Mailing address:
  • Phone: 773-761-2521
  • Fax: 773-761-2522

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: