Healthcare Provider Details

I. General information

NPI: 1033040357
Provider Name (Legal Business Name): J C KANIA DDS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2026
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2604 W NORTH AVE
CHICAGO IL
60647-5235
US

IV. Provider business mailing address

2604 W NORTH AVE
CHICAGO IL
60647-5235
US

V. Phone/Fax

Practice location:
  • Phone: 773-252-0033
  • Fax: 773-252-0033
Mailing address:
  • Phone: 773-252-0033
  • Fax: 773-252-0033

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. JOANN C KANIA CAROL KANIA
Title or Position: OWNER
Credential: DDS
Phone: 773-252-0033