Healthcare Provider Details

I. General information

NPI: 1619492907
Provider Name (Legal Business Name): NAANA MENSAH DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/08/2017
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1123 FAIRVIEW AVE
WESTMONT IL
60559-2709
US

IV. Provider business mailing address

2241 THEODORE ST
CREST HILL IL
60403-1881
US

V. Phone/Fax

Practice location:
  • Phone: 630-241-0300
  • Fax: 630-241-8587
Mailing address:
  • Phone: 815-741-1700
  • Fax: 815-483-2298

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number019.031338
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: