Provider Demographics
NPI:1689049165
Name:BEDRAN-RUSSO, ANA KARINA (DDS)
Entity Type:Individual
Prefix:
First Name:ANA KARINA
Middle Name:
Last Name:BEDRAN-RUSSO
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 1:801 S PAULINA ST
Mailing Address - Street 2:ROOM 531
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-7210
Mailing Address - Country:US
Mailing Address - Phone:312-413-9581
Mailing Address - Fax:312-996-3535
Practice Address - Street 1:801 S PAULINA ST
Practice Address - Street 2:ROOM 531
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-7210
Practice Address - Country:US
Practice Address - Phone:312-413-9581
Practice Address - Fax:312-996-3535
Is Sole Proprietor?:No
Enumeration Date:2015-12-09
Last Update Date:2015-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL136.000113122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist