Provider Demographics
NPI:1467624270
Name:DEVON DENTAL SURGERY, LTD
Entity Type:Organization
Organization Name:DEVON DENTAL SURGERY, LTD
Other - Org Name:CHICAGO ORAL CARE, LTD.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:NINA
Authorized Official - Middle Name:N
Authorized Official - Last Name:SANAI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:312-733-5811
Mailing Address - Street 1:1522 W CHICAGO AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60622-5236
Mailing Address - Country:US
Mailing Address - Phone:312-733-5811
Mailing Address - Fax:312-733-9511
Practice Address - Street 1:1522 W CHICAGO AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60622-5236
Practice Address - Country:US
Practice Address - Phone:312-733-5811
Practice Address - Fax:312-733-9511
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DEVON DENTAL SURGERY, LTD.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-04-01
Last Update Date:2008-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental