Healthcare Provider Details

I. General information

NPI: 1841600020
Provider Name (Legal Business Name): ASHLEY DREW KAUFFMAN DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2014
Last Update Date: 12/21/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4709 GOLF RD SUITE 1005
SKOKIE IL
60076-1231
US

IV. Provider business mailing address

4709 GOLF RD SUITE 1005
SKOKIE IL
60076-1231
US

V. Phone/Fax

Practice location:
  • Phone: 847-677-2404
  • Fax:
Mailing address:
  • Phone: 847-677-2404
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number019029794
License Number StateIL
# 2
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: