=====================================================
General NPI Number Information
=====================================================
NPI Number | 1821537838
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DANIEL J POPE, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/23/2017
-----------------------------------------------------
Last Update Date | 02/23/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 445 JACKSON AVE SUIET 104
-----------------------------------------------------
City | NAPERVILLE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60540-5256
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 630-961-5851
-----------------------------------------------------
Fax | 630-961-5898
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 445 JACKSON AVE SUIET 104
-----------------------------------------------------
City | NAPERVILLE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60540-5256
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 630-961-5851
-----------------------------------------------------
Fax | 630-961-5898
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. DANIEL J POPE
-----------------------------------------------------
Credential | D.D.S
-----------------------------------------------------
Telephone | 630-961-5851
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 019.025061
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------