Provider Demographics
NPI:1093124190
Name:JUMANI, ESAM (DDS)
Entity Type:Individual
Prefix:DR
First Name:ESAM
Middle Name:
Last Name:JUMANI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 N MCCLURG CT
Mailing Address - Street 2:APT 2215
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-4323
Mailing Address - Country:US
Mailing Address - Phone:917-544-1626
Mailing Address - Fax:
Practice Address - Street 1:200 W LAKE ST
Practice Address - Street 2:
Practice Address - City:ADDISON
Practice Address - State:IL
Practice Address - Zip Code:60101-2513
Practice Address - Country:US
Practice Address - Phone:630-628-3115
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-04
Last Update Date:2014-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.029987122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist