Provider Demographics
NPI:1881655694
Name:DEAVER, ROBERT S (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:S
Last Name:DEAVER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 E. WASHINGTON ST.
Mailing Address - Street 2:SUITE 1115
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60602
Mailing Address - Country:US
Mailing Address - Phone:312-726-1899
Mailing Address - Fax:312-726-1906
Practice Address - Street 1:25 E. WASHINGTON ST.
Practice Address - Street 2:#1115
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60602
Practice Address - Country:US
Practice Address - Phone:312-726-1899
Practice Address - Fax:312-726-1906
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-31
Last Update Date:2010-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019-183781223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice