MEDICARE: ISRAEL J WARENS DDS PC

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		IL

General Provider Information

NPI Number	:	1366650194
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ISRAEL J WARENS DDS PC

Provider Business Mailing Address
First Line	:	5406 W DEVON AVE
Second Line	:	SUITE 200
City	:	CHICAGO
State	:	IL
Zip	:	60646-4136
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5406 W DEVON AVE
Second Line	:	SUITE 200
City	:	CHICAGO
State	:	IL
Zip	:	60646-4136
Country	:	US
Telephone Number	:	773-792-1313
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. ISRAEL JACINTO WARENS
Credential	:	DDS
Telephone Number	:	773-792-1313

Provider Enumeration Date	:	05/17/2007
Last Update Date	:	08/22/2020

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