Provider Demographics
NPI:1407996580
Name:CHIC, SANDRA M (DDS)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:M
Last Name:CHIC
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 1:1344 MONTCLAIRE CIR
Mailing Address - Street 2:
Mailing Address - City:SCHAUMBURG
Mailing Address - State:IL
Mailing Address - Zip Code:60173-6180
Mailing Address - Country:US
Mailing Address - Phone:847-995-8408
Mailing Address - Fax:
Practice Address - Street 1:120 RIDGE AVE. SUITE 20
Practice Address - Street 2:
Practice Address - City:BLOOMINGDALE
Practice Address - State:IL
Practice Address - Zip Code:60108
Practice Address - Country:US
Practice Address - Phone:630-351-9944
Practice Address - Fax:630-351-7312
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2020-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019-0236441223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice