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General NPI Number Information
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NPI Number | 1396734026
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Entity Type | Organization
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Legal Business Name | PROVERBS 3 PC
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Dates
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Enumeration Date | 10/15/2005
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Last Update Date | 09/06/2013
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Provider Practice Location Address
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Address Line | 2447 W 79TH ST
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City | CHICAGO
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State | IL
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Zip | 60652-1734
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Country | US
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Telephone | 773-776-1285
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Fax | 773-776-3171
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Provider Business Mailing Address
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Address Line | PO BOX 20568
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City | CHICAGO
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State | IL
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Zip | 60620-0568
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Country | US
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Telephone | 773-776-1285
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Fax | 773-776-3171
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. PATRICIA JAMES
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Credential |
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Telephone | 773-776-1285
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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 | 019022143
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License Number State | IL
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