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General NPI Number Information
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NPI Number | 1245401124
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Entity Type | Organization
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Legal Business Name | ATHENA DENTAL INSTITUTE, P.C.
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Dates
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Enumeration Date | 03/18/2008
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Last Update Date | 01/01/2010
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Provider Practice Location Address
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Address Line | 116 W HUBBARD ST 6TH FLOOR
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City | CHICAGO
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State | IL
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Zip | 60654-8542
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Country | US
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Telephone | 312-527-1500
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1145 P.O. BOX 1145
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City | FRANKFORT
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State | IL
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Zip | 60423-7145
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Country | US
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Telephone | 312-527-1500
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | DR. ANDREA M MILLER FINCH
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Credential | D.D.S.
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Telephone | 312-527-1500
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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 | 019022059
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License Number State | IL
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