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General NPI Number Information
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NPI Number | 1154802130
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Entity Type | Organization
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Legal Business Name | TEETH MATTER INC.
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Dates
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Enumeration Date | 08/27/2018
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Last Update Date | 11/14/2018
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Provider Practice Location Address
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Address Line | 6418 W BELMONT AVE
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City | CHICAGO
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State | IL
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Zip | 60634-4099
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Country | US
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Telephone | 773-916-2500
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Fax | 773-337-0731
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Provider Business Mailing Address
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Address Line | 1658 N MILWAUKEE AVE SUITE 395 ATTN: W SALIH
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City | CHICAGO
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State | IL
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Zip | 60647
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Country | US
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Telephone | 773-622-7773
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Fax | 773-286-6767
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Authorized Official
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Title or Position | DENTIST
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Name | DR. EVA BLODA
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Credential | DDS
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Telephone | 773-622-7773
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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 |
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License Number State |
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