MEDICARE: DR. AMIT K DAS DDS,MS

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	:	1740328830
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AMIT K DAS DDS,MS

Provider Business Mailing Address
First Line	:	3900 W MADISON ST
Second Line	:	#14
City	:	CHICAGO
State	:	IL
Zip	:	60624-2354
Country	:	US
Telephone Number	:	773-533-3838
Fax Number	:	773-533-3839

Provider Business Practice Location Address
First Line	:	3900 W MADISON ST
Second Line	:	#14
City	:	CHICAGO
State	:	IL
Zip	:	60624-2354
Country	:	US
Telephone Number	:	773-533-3838
Fax Number	:	773-533-3839

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

Provider Enumeration Date	:	02/02/2007
Last Update Date	:	07/08/2007

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