MEDICARE: CHATHAM DENTAL, LTD

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	:	1477567386
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHATHAM DENTAL, LTD

Provider Business Mailing Address
First Line	:	8544 S STONY ISLAND AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60617-2248
Country	:	US
Telephone Number	:	773-221-0800
Fax Number	:	773-221-0868

Provider Business Practice Location Address
First Line	:	8544 S STONY ISLAND AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60617-2248
Country	:	US
Telephone Number	:	773-221-0800
Fax Number	:	773-221-0868

Authorized Official
Title or Position	:	DENTIST
Name	:	DR. RODNEY ALAN BLANEY
Credential	:	D.M.D
Telephone Number	:	773-221-0800

Provider Enumeration Date	:	07/28/2006
Last Update Date	:	08/22/2020

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