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General NPI Number Information
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NPI Number | 1275737207
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Entity Type | Organization
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Legal Business Name | LARAMIE DENTAL
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Dates
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Enumeration Date | 06/13/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2556 N LARAMIE
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City | CHICAGO
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State | IL
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Zip | 60639
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Country | US
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Telephone | 773-889-3333
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Fax | 773-889-3336
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Provider Business Mailing Address
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Address Line | 1700 W FOSTER
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City | CHICAGO
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State | IL
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Zip | 60640
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Country | US
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Telephone | 773-334-4200
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Fax | 773-334-4532
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Authorized Official
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Title or Position | OWNER
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Name | ANITA SHAHIN
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Credential | DDS
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Telephone | 773-334-4200
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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 | 01924538
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License Number State | IL
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