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General NPI Number Information
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NPI Number | 1912153479
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Entity Type | Organization
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Legal Business Name | ACCUDENT ASSOCIATES LLC
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Dates
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Enumeration Date | 08/14/2008
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Last Update Date | 04/18/2019
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Provider Practice Location Address
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Address Line | 811 S. WESTERN AVE
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City | CHICAGO
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State | IL
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Zip | 60612
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Country | US
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Telephone | 312-226-0210
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Fax | 312-226-0240
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Provider Business Mailing Address
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Address Line | 811 S. WESTERN AVE
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City | CHICAGO
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State | IL
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Zip | 60612
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Country | US
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Telephone | 312-226-0210
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Fax | 312-226-0240
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Authorized Official
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Title or Position | DENTIST
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Name | DR. THOMAS EDWARD SHIMODA
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Credential | DDS
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Telephone | 312-226-0210
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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 | 019016473
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License Number State | IL
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