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General NPI Number Information
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NPI Number | 1932370160
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Entity Type | Organization
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Legal Business Name | G & A DENTAL PC
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Dates
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Enumeration Date | 03/15/2008
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Last Update Date | 11/06/2013
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Provider Practice Location Address
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Address Line | 1514 W DEVON AVE
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City | CHICAGO
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State | IL
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Zip | 60660
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Country | US
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Telephone | 773-465-4500
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Fax | 773-353-2102
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Provider Business Mailing Address
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Address Line | P.O. BOX 564
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City | LAKE BLUFF
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State | IL
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Zip | 60044
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Country | US
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Telephone | 773-465-4500
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Fax | 773-353-2102
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ALEXANDRA ANDERSON
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Credential | DDS
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Telephone | 773-465-4500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 060009736
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License Number State | IL
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