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General NPI Number Information
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NPI Number | 1790957884
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Entity Type | Organization
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Legal Business Name | CITY OF EVANSTON
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Dates
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Enumeration Date | 03/28/2008
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Last Update Date | 03/28/2008
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Provider Practice Location Address
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Address Line | 2100 RIDGE AVE CHILDREN'S DENTAL CLINIC
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City | EVANSTON
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State | IL
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Zip | 60201-2716
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Country | US
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Telephone | 847-866-2953
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Fax | 847-448-8134
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Provider Business Mailing Address
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Address Line | 2100 RIDGE AVE CHILDREN'S DENTAL CLINIC
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City | EVANSTON
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State | IL
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Zip | 60201-2716
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Country | US
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Telephone | 847-866-2953
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Fax | 847-448-8134
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Authorized Official
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Title or Position | CHIEF, COMMUNITY HEALTH SERVICES
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Name | CARLA BUSH
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Credential |
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Telephone | 847-328-2100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP0905X
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Taxonomy Name | State or Local Public Health Clinic/Center
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License Number |
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License Number State | IL
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