Healthcare Provider Details

I. General information

NPI: 1174962450
Provider Name (Legal Business Name): SAMIA M SULEIMAN-ATA D.D.S., M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2013
Last Update Date: 11/29/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13600 ROUTE 59 SUITE 2
PLAINFIELD IL
60544
US

IV. Provider business mailing address

13600 ROUTE 59 SUITE 2
PLAINFIELD IL
60544
US

V. Phone/Fax

Practice location:
  • Phone: 779-939-0010
  • Fax: 630-778-2070
Mailing address:
  • Phone: 779-939-0010
  • Fax: 630-778-2070

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number021.002785
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number019029448
License Number StateIL

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
IdentifierAAFDEN3BBS
Identifier TypeOTHER
Identifier StateIL
Identifier IssuerBLUE CROSS BLUE SHIELD IL
# 2
Identifier564197
Identifier TypeOTHER
Identifier StateIL
Identifier IssuerUNITED CONCORDIA
# 3
Identifier62113329
Identifier TypeOTHER
Identifier StateAL
Identifier IssuerBLUE CROSS BLUE SHIELD AL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: