Provider Demographics
NPI:1689789745
Name:MERRILL CHUDY, ELEANOR B (DDS)
Entity Type:Individual
Prefix:
First Name:ELEANOR
Middle Name:B
Last Name:MERRILL CHUDY
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 1:1655 N MILWAUKEE AVE
Mailing Address - Street 2:
Mailing Address - City:LIBERTYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60048-1314
Mailing Address - Country:US
Mailing Address - Phone:847-549-1144
Mailing Address - Fax:847-549-9088
Practice Address - Street 1:1655 N MILWAUKEE AVE
Practice Address - Street 2:
Practice Address - City:LIBERTYVILLE
Practice Address - State:IL
Practice Address - Zip Code:60048-1314
Practice Address - Country:US
Practice Address - Phone:847-549-1144
Practice Address - Fax:847-549-9088
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist