MEDICARE: MR. ALEXANDER K CHIAMBAS DDS

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	021879	IL

General Provider Information

NPI Number	:	1427110394
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ALEXANDER K CHIAMBAS DDS

Provider Business Mailing Address
First Line	:	601 W CENTRAL ROAD
Second Line	:	SUITE 2
City	:	MOUNT PROSPECT
State	:	IL
Zip	:	60056-2379
Country	:	US
Telephone Number	:	847-255-0777
Fax Number	:	847-255-0777

Provider Business Practice Location Address
First Line	:	601 W CENTRAL ROAD
Second Line	:	SUITE 2
City	:	MOUNT PROSPECT
State	:	IL
Zip	:	60056-2379
Country	:	US
Telephone Number	:	847-255-0777
Fax Number	:	847-255-0777

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

Provider Enumeration Date	:	12/15/2006
Last Update Date	:	07/08/2007

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