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General NPI Number Information
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NPI Number | 1912255910
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Entity Type | Individual
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Provider Name | ANDREA VENIZELOS NUNNEY DDS, MS
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Gender | Female
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Dates
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Enumeration Date | 08/22/2012
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Last Update Date | 08/22/2012
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Provider Practice Location Address
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Address Line | 801 S PAULINA ST ROOM 304 G
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City | CHICAGO
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State | IL
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Zip | 60612-7210
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Country | US
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Telephone | 312-996-7514
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Fax |
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Provider Business Mailing Address
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Address Line | 1234 N WOLCOTT AVE APT 1
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City | CHICAGO
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State | IL
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Zip | 60622-3882
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Country | US
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Telephone | 216-470-7767
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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 | 019.029185
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License Number State | IL
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