=====================================================
General NPI Number Information
=====================================================
NPI Number | 1619140993
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JULIAN RAMIREZ DDS AND ASSOCIATES PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/08/2008
-----------------------------------------------------
Last Update Date | 03/09/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4421 N CENTRAL AVE
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60630-3301
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 773-282-6446
-----------------------------------------------------
Fax | 773-282-8019
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4421 N CENTRAL AVE
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60630-3301
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 773-282-6446
-----------------------------------------------------
Fax | 773-282-8019
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. VICTOR HUGO RAMIREZ
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 773-247-0404
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 019025051
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------