=====================================================
General NPI Number Information
=====================================================
NPI Number | 1639342272
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DRS. DUDLEY, ROBINSON, JAMES, LTD.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/03/2008
-----------------------------------------------------
Last Update Date | 04/17/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1500 E 87TH ST
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60619-6525
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 773-721-1333
-----------------------------------------------------
Fax | 773-721-1730
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1500 E 87TH ST
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60619-6525
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 773-721-1333
-----------------------------------------------------
Fax | 773-721-1730
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DENTIST
-----------------------------------------------------
Name | DR. MARK ANTHONY ROBINSON
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 773-721-1333
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 019-13341
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------