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General NPI Number Information
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NPI Number | 1174951123
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Entity Type | Organization
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Legal Business Name | AJD DENTAL GROUP INC
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Dates
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Enumeration Date | 10/29/2013
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Last Update Date | 10/29/2013
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Provider Practice Location Address
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Address Line | 5037 N HARLEM AVE
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City | CHICAGO
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State | IL
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Zip | 60656-3501
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Country | US
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Telephone | 773-763-3600
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Fax | 773-763-1711
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Provider Business Mailing Address
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Address Line | 5037 N HARLEM AVE
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City | CHICAGO
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State | IL
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Zip | 60656-3501
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Country | US
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Telephone | 773-763-3600
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Fax | 773-763-1711
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ATHINA J DANIGELES
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Credential | DDS
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Telephone | 773-763-3600
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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 | 019020718
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License Number State | IL
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