Provider Demographics
NPI:1821630054
Name:NEAR NORTH HEALTH
Entity Type:Organization
Organization Name:NEAR NORTH HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTAL HYGIENIST
Authorized Official - Prefix:
Authorized Official - First Name:DESTENII
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMAS ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:RDH
Authorized Official - Phone:773-629-5488
Mailing Address - Street 1:4259 S BERKELEY AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60653-3030
Mailing Address - Country:US
Mailing Address - Phone:773-629-5488
Mailing Address - Fax:
Practice Address - Street 1:4259 S BERKELEY AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60653-3030
Practice Address - Country:US
Practice Address - Phone:773-629-5488
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-09
Last Update Date:2019-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes124Q00000XDental ProvidersDental HygienistGroup - Single Specialty