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General NPI Number Information
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NPI Number | 1952781916
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Entity Type | Organization
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Legal Business Name | UNIVERSITY OF ILLINOIS AT CHICAGO COLLEGE OF DENTISTRY
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Dates
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Enumeration Date | 06/04/2015
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Last Update Date | 06/04/2015
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Provider Practice Location Address
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Address Line | 801 S PAULINA ST 465B
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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 | 312-355-4819
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Fax |
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Provider Business Mailing Address
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Address Line | 1201 S PRAIRIE AVE 4901
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City | CHICAGO
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State | IL
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Zip | 60605-3325
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Country | US
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Telephone | 312-522-8417
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Fax |
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Authorized Official
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Title or Position | CHAIRMAN, DEPT. OF PERIODONTOLOGY
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Name | DR. SAVALDOR NARES
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Credential | DDS, MS, PHD
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Telephone | 312-413-4467
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 019.029769
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License Number State | IL
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