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General NPI Number Information
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NPI Number | 1093656290
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Entity Type | Organization
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Legal Business Name | DENTELLIGENCE INC
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Dates
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Enumeration Date | 04/02/2026
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Last Update Date | 04/02/2026
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Provider Practice Location Address
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Address Line | 1298 S MILWAUKEE AVE
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City | LIBERTYVILLE
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State | IL
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Zip | 60048-3784
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Country | US
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Telephone | 847-316-0679
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Fax |
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Provider Business Mailing Address
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Address Line | 1618 ELDERBERRY DR
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City | LIBERTYVILLE
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State | IL
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Zip | 60048-5306
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | ANNIE MIRZA
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Credential | DDS
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Telephone | 331-425-0937
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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