MEDICARE: DR. EDWARD VAYMAN 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		IL

General Provider Information

NPI Number	:	1629067848
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EDWARD VAYMAN DDS

Provider Business Mailing Address
First Line	:	3414 W PETERSON AVE
Second Line	:	SU. B
City	:	CHICAGO
State	:	IL
Zip	:	60659-3452
Country	:	US
Telephone Number	:	773-583-9045
Fax Number	:	773-583-9045

Provider Business Practice Location Address
First Line	:	3414 W PETERSON AVE
Second Line	:	SU. B
City	:	CHICAGO
State	:	IL
Zip	:	60659-3452
Country	:	US
Telephone Number	:	773-583-9045
Fax Number	:	773-583-9045

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

Provider Enumeration Date	:	10/20/2005
Last Update Date	:	07/08/2007

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