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NPI Code Detail

MEDICARE: SUSEJ BANDRES DMD

MEDICARE: SUSEJ BANDRES DMD
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
1122300000XDentist019.037085IL

General Provider Information

NPI Number : 1548192040
Entity Type Code : Individual
Provider Name (Legal Business Name) : SUSEJ BANDRES DMD
Provider Business Mailing Address
First Line : 355 N HALSTED ST APT 1910
Second Line :
City : CHICAGO
State : IL
Zip : 60661-2354
Country : US
Telephone Number : 407-965-7962
Fax Number :
Provider Business Practice Location Address
First Line : 3450 S ARCHER AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60608-6837
Country : US
Telephone Number : 872-314-1807
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/01/2026
Last Update Date : 06/01/2026

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Directions to “ SUSEJ BANDRES DMD” Practice Location

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