Provider Demographics
NPI:1598800096
Name:MOSKIN, JEANNIE (DDS)
Entity Type:Individual
Prefix:MRS
First Name:JEANNIE
Middle Name:
Last Name:MOSKIN
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 1:5131 N LINCOLN AVE
Mailing Address - Street 2:P.O. BOX 257353
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60625-2585
Mailing Address - Country:US
Mailing Address - Phone:773-271-5596
Mailing Address - Fax:773-271-7842
Practice Address - Street 1:5131 N LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60625-2585
Practice Address - Country:US
Practice Address - Phone:773-271-5596
Practice Address - Fax:773-271-7842
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist