Healthcare Provider Details

I. General information

NPI: 1457482036
Provider Name (Legal Business Name): SUZANNE SCHNEEGAS-MAHONEY DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/08/2007
Last Update Date: 07/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 N. COUNTY FARM RD.
WHEATON IL
60187-3988
US

IV. Provider business mailing address

843 S KEARSAGE AVE
ELMHURST IL
60126-4454
US

V. Phone/Fax

Practice location:
  • Phone: 630-682-7979
  • Fax: 630-462-9249
Mailing address:
  • Phone: 630-833-8431
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License Number019020485
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: