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General NPI Number Information
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NPI Number | 1861895468
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Entity Type | Organization
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Legal Business Name | SAPPHIRE DENTAL LLC
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Dates
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Enumeration Date | 09/27/2014
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Last Update Date | 09/27/2014
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Provider Practice Location Address
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Address Line | 727 RIDGEVIEW DR
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City | MCHENRY
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State | IL
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Zip | 60050-7054
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Country | US
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Telephone | 847-977-7851
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Fax | 847-307-5178
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Provider Business Mailing Address
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Address Line | 2775 ALGONQUIN RD SUITE 200
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City | ROLLING MEADOWS
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State | IL
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Zip | 60008-3829
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Country | US
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Telephone | 847-977-7851
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Fax | 847-307-5178
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Authorized Official
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Title or Position | GENERAL DENTIST
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Name | DR. IEVA DABEKA
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Credential | D.D.S.
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Telephone | 847-977-7851
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 019.030054
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License Number State | IL
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