Healthcare Provider Details

I. General information

NPI: 1184008930
Provider Name (Legal Business Name): ESAM JUMANI D.D.S.,P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2015
Last Update Date: 07/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17500 E CARRIAGEWAY DR SUITE B
HAZEL CREST IL
60429-2057
US

IV. Provider business mailing address

17500 E CARRIAGEWAY DR SUITE B
HAZEL CREST IL
60429-2057
US

V. Phone/Fax

Practice location:
  • Phone: 708-799-1300
  • Fax:
Mailing address:
  • Phone: 708-799-1300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number019.029987
License Number StateIL

VIII. Authorized Official

Name: DR. ESAM JUMANI
Title or Position: PRESIDENT
Credential: D.D.S
Phone: 917-544-1626