Healthcare Provider Details

I. General information

NPI: 1821776477
Provider Name (Legal Business Name): QUANTUM DENTAL SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2023
Last Update Date: 07/05/2023
Certification Date: 07/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1820 W WEBSTER AVE STE 110
CHICAGO IL
60614-2934
US

IV. Provider business mailing address

1820 W WEBSTER AVE STE 110
CHICAGO IL
60614-2934
US

V. Phone/Fax

Practice location:
  • Phone: 888-987-1489
  • Fax:
Mailing address:
  • Phone: 888-987-1489
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: EUGENE VAYMAN
Title or Position: PRESIDENT
Credential:
Phone: 888-987-1489