MEDICARE: PAUL M ANFENSON D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	19061	IL

General Provider Information

NPI Number	:	1114967262
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAUL M ANFENSON D.D.S.

Provider Business Mailing Address
First Line	:	115 S WILKE RD
Second Line	:	SUITE 104
City	:	ARLINGTON HEIGHTS
State	:	IL
Zip	:	60005-1532
Country	:	US
Telephone Number	:	847-253-0195
Fax Number	:

Provider Business Practice Location Address
First Line	:	115 S WILKE RD
Second Line	:	SUITE 104
City	:	ARLINGTON HEIGHTS
State	:	IL
Zip	:	60005-1532
Country	:	US
Telephone Number	:	847-253-0195
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/07/2006
Last Update Date	:	07/08/2007

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