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General NPI Number Information
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NPI Number | 1427889856
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Entity Type | Individual
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Provider Name | MIRA SUVAGIA DMD, MS
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Gender | Female
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Dates
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Enumeration Date | 08/08/2024
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Last Update Date | 03/21/2025
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Provider Practice Location Address
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Address Line | 1137 N PROSPECT AVE # C101
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City | ITASCA
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State | IL
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Zip | 60143-1437
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Country | US
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Telephone | 630-338-7740
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Fax |
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Provider Business Mailing Address
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Address Line | 9N946 HEATHERINGTON PL
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City | ELGIN
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State | IL
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Zip | 60124-8351
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Country | US
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Telephone | 630-338-7740
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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 | 019.033765
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 021.003389
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License Number State | IL
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