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5131 W Devon Ave Chicago IL 60646-4217 | |
| (773) 631-8717 | |
| (773) 631-7781 |
| Full Name | |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 5131 W Devon Ave, Chicago, Illinois |
| Authorized Official Name and Position | Sam Dauahera (OWNER) |
| Authorized Official Contact | 7734565659 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
5131 W Devon Ave Chicago IL 60646-4217 Ph: (773) 631-8717 | 5131 W Devon Ave Chicago IL 60646-4217 Ph: (773) 631-8717 |
| NPI Number | 1992046205 |
|---|---|
| Provider Enumeration Date | 03/12/2013 |
| Last Update Date | 03/12/2013 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1992046205 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 019027577 (Illinois) | Primary |
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