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General NPI Number Information
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NPI Number | 1144759291
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Entity Type | Individual
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Provider Name | SYDNEY CHARNESKI DMD
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Gender | Female
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Dates
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Enumeration Date | 06/11/2017
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Last Update Date | 06/11/2017
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Provider Practice Location Address
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Address Line | 6749 N OSHKOSH AVE
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City | CHICAGO
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State | IL
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Zip | 60631-1162
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Country | US
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Telephone | 773-631-5141
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Fax |
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Provider Business Mailing Address
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Address Line | 605 W MADISON ST APT 3211
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City | CHICAGO
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State | IL
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Zip | 60661-2443
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Country | US
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Telephone | 612-987-8150
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Fax |
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 019031139
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License Number State | IL
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