Provider Demographics
NPI:1639859606
Name:SUAREZ, CHEYENNE ADALIA DEVON (DMD)
Entity Type:Individual
Prefix:
First Name:CHEYENNE
Middle Name:ADALIA DEVON
Last Name:SUAREZ
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 1:1601 FAIRWAY DR APT 1G
Mailing Address - Street 2:
Mailing Address - City:LISLE
Mailing Address - State:IL
Mailing Address - Zip Code:60532-3091
Mailing Address - Country:US
Mailing Address - Phone:253-736-3606
Mailing Address - Fax:
Practice Address - Street 1:5060 ACE LN STE 100
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60564-8373
Practice Address - Country:US
Practice Address - Phone:630-904-4444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-24
Last Update Date:2023-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.0343761223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice