Healthcare Provider Details

I. General information

NPI: 1679034540
Provider Name (Legal Business Name): DANIELLE DUARTE DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/25/2019
Last Update Date: 01/16/2023
Certification Date: 01/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2611 BROADWAY AVE
EVANSTON IL
60201-1501
US

IV. Provider business mailing address

1555 RIDGE AVE APT 317
EVANSTON IL
60201-4185
US

V. Phone/Fax

Practice location:
  • Phone: 847-532-2688
  • Fax:
Mailing address:
  • Phone: 630-267-7447
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number019032181
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number019.032181
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: