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General NPI Number Information
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NPI Number | 1104260884
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Entity Type | Organization
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Legal Business Name | DURAES JHAM DENTAL, P.C
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Dates
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Enumeration Date | 04/24/2013
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Last Update Date | 04/24/2013
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Provider Practice Location Address
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Address Line | 156A EAST LAKE STREET
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City | BLOOMINGDALE
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State | IL
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Zip | 60108-1263
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Country | US
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Telephone | 708-834-3602
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Fax |
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Provider Business Mailing Address
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Address Line | 156A EAST LAKE STREET
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City | BLOOMINGDALE
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State | IL
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Zip | 60108-1263
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Country | US
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Telephone | 708-834-3602
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | GABRIELA DURAES
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Credential | DDS
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Telephone | 708-834-3602
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 019028921
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License Number State | IL
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