Healthcare Provider Details

I. General information

NPI: 1316006307
Provider Name (Legal Business Name): EAST ERIE DENTAL ASSOCIATES, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

233 E ERIE ST SUITE 406
CHICAGO IL
60611-2926
US

IV. Provider business mailing address

233 E ERIE ST SUITE 406
CHICAGO IL
60611-2926
US

V. Phone/Fax

Practice location:
  • Phone: 312-587-0200
  • Fax: 312-587-0223
Mailing address:
  • Phone: 312-587-0200
  • Fax: 312-587-0223

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code305R00000X
TaxonomyPreferred Provider Organization
License Number
License Number StateIL

VIII. Authorized Official

Name: DR. TAN MINGH NGUYEN
Title or Position: PRESIDENT
Credential: D.D.S.
Phone: 312-587-0200