Provider Demographics
NPI:1366861296
Name:HANSON & SEVANDAL DENTISTRY, LLC
Entity Type:Organization
Organization Name:HANSON & SEVANDAL DENTISTRY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:MAUREEN
Authorized Official - Middle Name:
Authorized Official - Last Name:SEVANDAL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:312-493-6102
Mailing Address - Street 1:2570 FOXFIELD RD STE 203
Mailing Address - Street 2:
Mailing Address - City:ST CHARLES
Mailing Address - State:IL
Mailing Address - Zip Code:60174-1406
Mailing Address - Country:US
Mailing Address - Phone:630-587-4444
Mailing Address - Fax:630-587-5811
Practice Address - Street 1:2570 FOXFIELD RD STE 203
Practice Address - Street 2:
Practice Address - City:ST CHARLES
Practice Address - State:IL
Practice Address - Zip Code:60174-1406
Practice Address - Country:US
Practice Address - Phone:630-587-4444
Practice Address - Fax:630-587-5811
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-08
Last Update Date:2014-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.0267061223P0221X
IL0190266491223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty