MEDICARE: MARIA SINIS DMD 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	122300000X	Dentist	DN19022	FL
2	122300000X	Dentist	019028502	IL

General Provider Information

NPI Number	:	1669782736
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARIA SINIS DMD LTD

Provider Business Mailing Address
First Line	:	1120 MIDWAY RD
Second Line	:
City	:	NORTHBROOK
State	:	IL
Zip	:	60062-3938
Country	:	US
Telephone Number	:	224-213-7289
Fax Number	:	773-262-9850

Provider Business Practice Location Address
First Line	:	6428 N CALIFORNIA AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60645-5209
Country	:	US
Telephone Number	:	773-973-0531
Fax Number	:	773-262-9850

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. MARIA SINIS
Credential	:	D.M.D.
Telephone Number	:	954-663-6804

Provider Enumeration Date	:	10/07/2010
Last Update Date	:	10/07/2010

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