Healthcare Provider Details

I. General information

NPI: 1639327570
Provider Name (Legal Business Name): ALES OBREZ D.M.D., PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/04/2008
Last Update Date: 09/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 S PAULINA ST RM 204K
CHICAGO IL
60612-7210
US

IV. Provider business mailing address

801 S PAULINA ST RM 204K
CHICAGO IL
60612-7210
US

V. Phone/Fax

Practice location:
  • Phone: 312-996-4977
  • Fax: 312-996-3535
Mailing address:
  • Phone: 312-996-4977
  • Fax: 312-996-3535

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number019021240
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: