Provider Demographics
NPI:1396372777
Name:VRANAS, EVANTHIA NICOLE (DMD)
Entity Type:Individual
Prefix:
First Name:EVANTHIA
Middle Name:NICOLE
Last Name:VRANAS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 N WABASH AVE STE 1921
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60602-2970
Mailing Address - Country:US
Mailing Address - Phone:312-332-4424
Mailing Address - Fax:
Practice Address - Street 1:111 N WABASH AVE STE 1921
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60602-2970
Practice Address - Country:US
Practice Address - Phone:312-332-4424
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-25
Last Update Date:2021-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.0326531223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice