Provider Demographics
NPI:1164723565
Name:ADVANCED IMAGING STUDIO, INC.
Entity Type:Organization
Organization Name:ADVANCED IMAGING STUDIO, INC.
Other - Org Name:AIS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:EROS
Authorized Official - Middle Name:
Authorized Official - Last Name:SANTOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-283-3232
Mailing Address - Street 1:4307 N CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60634-1815
Mailing Address - Country:US
Mailing Address - Phone:773-283-3232
Mailing Address - Fax:772-283-3205
Practice Address - Street 1:4307 N CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60634-1815
Practice Address - Country:US
Practice Address - Phone:773-283-3232
Practice Address - Fax:772-283-3205
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-16
Last Update Date:2010-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL319012418122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty