MEDICARE: DR. ROBERT S DEAVER 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	019-18378	IL

General Provider Information

NPI Number	:	1881655694
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT S DEAVER DDS

Provider Business Mailing Address
First Line	:	25 E. WASHINGTON ST.
Second Line	:	SUITE 1115
City	:	CHICAGO
State	:	IL
Zip	:	60602
Country	:	US
Telephone Number	:	312-726-1899
Fax Number	:	312-726-1906

Provider Business Practice Location Address
First Line	:	25 E. WASHINGTON ST.
Second Line	:	#1115
City	:	CHICAGO
State	:	IL
Zip	:	60602
Country	:	US
Telephone Number	:	312-726-1899
Fax Number	:	312-726-1906

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

Provider Enumeration Date	:	03/31/2006
Last Update Date	:	03/11/2010

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