Provider Demographics
NPI:1083226781
Name:ANTWI, MAAME-AMA A (DMD)
Entity Type:Individual
Prefix:DR
First Name:MAAME-AMA
Middle Name:A
Last Name:ANTWI
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1370 E 53RD ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60615-4496
Mailing Address - Country:US
Mailing Address - Phone:773-731-3300
Mailing Address - Fax:
Practice Address - Street 1:1370 E 53RD ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60615-4496
Practice Address - Country:US
Practice Address - Phone:773-731-3300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-24
Last Update Date:2022-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.3304031223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice