Provider Demographics
NPI:1205827300
Name:KANIA, JOANN CAROL (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOANN
Middle Name:CAROL
Last Name:KANIA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2322 N MAPLEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60647-3129
Mailing Address - Country:US
Mailing Address - Phone:312-505-5987
Mailing Address - Fax:
Practice Address - Street 1:5137 W CHICAGO AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60651-2904
Practice Address - Country:US
Practice Address - Phone:773-378-4694
Practice Address - Fax:773-378-1294
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-31
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1002444Medicaid
U21428Medicare UPIN
IL1002444Medicaid