Provider Demographics
NPI:1891857546
Name:DANI, MIRIAM LEVITAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:MIRIAM
Middle Name:LEVITAN
Last Name:DANI
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 1:432 GREEN BAY RD
Mailing Address - Street 2:
Mailing Address - City:KENILWORTH
Mailing Address - State:IL
Mailing Address - Zip Code:60043-1001
Mailing Address - Country:US
Mailing Address - Phone:847-256-7700
Mailing Address - Fax:847-256-7710
Practice Address - Street 1:432 GREEN BAY RD
Practice Address - Street 2:
Practice Address - City:KENILWORTH
Practice Address - State:IL
Practice Address - Zip Code:60043-1001
Practice Address - Country:US
Practice Address - Phone:847-256-7700
Practice Address - Fax:847-256-7710
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist