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General NPI Number Information
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NPI Number | 1104062207
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Entity Type | Individual
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Provider Name | NICHOLE LEE DEMARS DDS
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Gender | Female
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Dates
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Enumeration Date | 12/20/2008
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Last Update Date | 01/28/2021
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Provider Practice Location Address
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Address Line | 3976 IL ROUTE 22 STE E
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City | LONG GROVE
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State | IL
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Zip | 60047-5318
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Country | US
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Telephone | 847-719-1973
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Fax | 847-719-1975
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Provider Business Mailing Address
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Address Line | 2155 W ROSCOE ST
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City | CHICAGO
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State | IL
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Zip | 60618-6260
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Country | US
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Telephone | 773-528-3384
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Fax | 773-528-3604
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 019-025986
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License Number State | IL
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