Provider Demographics
NPI:1558043117
Name:JANDALI, NORA (DMD)
Entity Type:Individual
Prefix:DR
First Name:NORA
Middle Name:
Last Name:JANDALI
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 1:55 E ERIE ST APT 5101
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-2262
Mailing Address - Country:US
Mailing Address - Phone:262-237-7994
Mailing Address - Fax:
Practice Address - Street 1:1254 N WELLS ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60610-1981
Practice Address - Country:US
Practice Address - Phone:312-337-3300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-03
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.0343261223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice