Provider Demographics
NPI:1346788395
Name:AFFINITY DENTAL
Entity Type:Organization
Organization Name:AFFINITY DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/PRACTICE OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LANA
Authorized Official - Middle Name:SAVOIE
Authorized Official - Last Name:KAVETSIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-904-7079
Mailing Address - Street 1:2015 W IRVING PARK RD
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60618-3909
Mailing Address - Country:US
Mailing Address - Phone:773-904-7079
Mailing Address - Fax:773-698-7832
Practice Address - Street 1:2015 W IRVING PARK RD
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60618-3909
Practice Address - Country:US
Practice Address - Phone:773-904-7079
Practice Address - Fax:773-698-7832
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-09
Last Update Date:2017-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty