Provider Demographics
NPI:1184008930
Name:ESAM JUMANI D.D.S.,P.C.
Entity Type:Organization
Organization Name:ESAM JUMANI D.D.S.,P.C.
Other - Org Name:ARTISTIC FAMILY DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ESAM
Authorized Official - Middle Name:
Authorized Official - Last Name:JUMANI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:917-544-1626
Mailing Address - Street 1:17500 E CARRIAGEWAY DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:HAZEL CREST
Mailing Address - State:IL
Mailing Address - Zip Code:60429-2057
Mailing Address - Country:US
Mailing Address - Phone:708-799-1300
Mailing Address - Fax:
Practice Address - Street 1:17500 E CARRIAGEWAY DR
Practice Address - Street 2:SUITE B
Practice Address - City:HAZEL CREST
Practice Address - State:IL
Practice Address - Zip Code:60429-2057
Practice Address - Country:US
Practice Address - Phone:708-799-1300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-10
Last Update Date:2015-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.029987122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty