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General NPI Number Information
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NPI Number | 1205827300
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Entity Type | Individual
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Provider Name | JOANN CAROL KANIA DDS
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Gender | Female
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Dates
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Enumeration Date | 10/31/2005
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 5137 W CHICAGO AVE
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City | CHICAGO
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State | IL
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Zip | 60651-2904
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Country | US
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Telephone | 773-378-4694
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Fax | 773-378-1294
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Provider Business Mailing Address
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Address Line | 2322 N MAPLEWOOD AVE
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City | CHICAGO
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State | IL
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Zip | 60647-3129
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Country | US
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Telephone | 312-505-5987
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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 | 019017465
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License Number State | IL
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