Provider Demographics
NPI:1811621113
Name:JANSKY, ANNAMARIE CIANCIO (DDS)
Entity Type:Individual
Prefix:
First Name:ANNAMARIE
Middle Name:CIANCIO
Last Name:JANSKY
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 1:324 N JEFFERSON ST APT 108
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60661-1249
Mailing Address - Country:US
Mailing Address - Phone:630-743-1252
Mailing Address - Fax:
Practice Address - Street 1:18650 DIXIE HWY
Practice Address - Street 2:
Practice Address - City:HOMEWOOD
Practice Address - State:IL
Practice Address - Zip Code:60430-3700
Practice Address - Country:US
Practice Address - Phone:708-315-2764
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-12
Last Update Date:2022-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.033876122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist