Provider Demographics
NPI:1093053167
Name:VENUS DE MILO DENTISTRY
Entity Type:Organization
Organization Name:VENUS DE MILO DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:REEM
Authorized Official - Middle Name:M
Authorized Official - Last Name:OBAISI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:773-588-9200
Mailing Address - Street 1:3334 W PETERSON AVE
Mailing Address - Street 2:LOWER LEVEL
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60659-3505
Mailing Address - Country:US
Mailing Address - Phone:773-588-9200
Mailing Address - Fax:773-588-9201
Practice Address - Street 1:3334 W PETERSON AVE
Practice Address - Street 2:LOWER LEVEL
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60659-3505
Practice Address - Country:US
Practice Address - Phone:773-588-9200
Practice Address - Fax:773-588-9201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-24
Last Update Date:2013-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019027619261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental