MEDICARE: DR. NANCY J.O. ABDALA 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	122300000X	Dentist	019015662	IL

General Provider Information

NPI Number	:	1467682302
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NANCY J.O. ABDALA D.D.S.

Provider Business Mailing Address
First Line	:	3321 N. PULASKI RD.
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60641
Country	:	US
Telephone Number	:	773-282-2077
Fax Number	:	773-282-4344

Provider Business Practice Location Address
First Line	:	3321 N. PULASKI RD.
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60641
Country	:	US
Telephone Number	:	773-282-2077
Fax Number	:	773-282-4344

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

Provider Enumeration Date	:	07/24/2009
Last Update Date	:	07/24/2009

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