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General NPI Number Information
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NPI Number | 1811621113
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Entity Type | Individual
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Provider Name | ANNAMARIE CIANCIO JANSKY DDS
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Gender | Female
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Dates
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Enumeration Date | 07/12/2022
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Last Update Date | 12/23/2024
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Provider Practice Location Address
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Address Line | 1 W HARRIS AVENUE #2A
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City | LA GRANGE
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State | IL
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Zip | 60525
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Country | US
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Telephone | 708-482-0702
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Fax |
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Provider Business Mailing Address
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Address Line | 324 N JEFFERSON ST APT 108
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City | CHICAGO
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State | IL
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Zip | 60661-1249
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Country | US
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Telephone | 630-743-1252
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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 | 019.033876
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License Number State | IL
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