Healthcare Provider Details

I. General information

NPI: 1346004801
Provider Name (Legal Business Name): DDSSCAN, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2024
Last Update Date: 02/06/2024
Certification Date: 02/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7408 KENNETH AVE
SKOKIE IL
60076-3818
US

IV. Provider business mailing address

7408 KENNETH AVE
SKOKIE IL
60076-3818
US

V. Phone/Fax

Practice location:
  • Phone: 773-592-1122
  • Fax:
Mailing address:
  • Phone: 877-722-6337
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ADMIR RAMIC
Title or Position: OWNER
Credential:
Phone: 773-592-1122