=====================================================
General NPI Number Information
=====================================================
NPI Number | 1316122344
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BANA ATASSI DDS
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/09/2008
-----------------------------------------------------
Last Update Date | 10/08/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 801 PLAINFIELD RD
-----------------------------------------------------
City | DARIEN
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60561-4286
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 630-769-9940
-----------------------------------------------------
Fax | 630-323-4909
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 801 PLAINFIELD RD
-----------------------------------------------------
City | DARIEN
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60561-4286
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 630-769-9940
-----------------------------------------------------
Fax | 630-323-4909
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 091023267
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------