Provider Demographics
NPI:1437673175
Name:DR. JOANN C KANIA DDS LTD
Entity Type:Organization
Organization Name:DR. JOANN C KANIA DDS LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOANN
Authorized Official - Middle Name:CAROL
Authorized Official - Last Name:KANIA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:312-505-5987
Mailing Address - Street 1:2322 N MAPLEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60647-3129
Mailing Address - Country:US
Mailing Address - Phone:312-505-5987
Mailing Address - Fax:
Practice Address - Street 1:6019 W BELMONT AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60634-5116
Practice Address - Country:US
Practice Address - Phone:773-745-7188
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-02
Last Update Date:2017-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental