Provider Demographics
NPI:1245401124
Name:ATHENA DENTAL INSTITUTE, P.C.
Entity Type:Organization
Organization Name:ATHENA DENTAL INSTITUTE, P.C.
Other - Org Name:ATHENA DENTAL GROUP OF CHICAGO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:M
Authorized Official - Last Name:MILLER FINCH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:312-527-1500
Mailing Address - Street 1:PO BOX 1145
Mailing Address - Street 2:P.O. BOX 1145
Mailing Address - City:FRANKFORT
Mailing Address - State:IL
Mailing Address - Zip Code:60423-7145
Mailing Address - Country:US
Mailing Address - Phone:312-527-1500
Mailing Address - Fax:
Practice Address - Street 1:116 W HUBBARD ST
Practice Address - Street 2:6TH FLOOR
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60654-8542
Practice Address - Country:US
Practice Address - Phone:312-527-1500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-18
Last Update Date:2010-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190220591223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1002966Medicaid
IL1124028113OtherNPI