Provider Demographics
NPI:1902392863
Name:DEARMOND, DANIELLE (DDS)
Entity Type:Individual
Prefix:DR
First Name:DANIELLE
Middle Name:
Last Name:DEARMOND
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 1:150 N WACKER DR STE 1320
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60606-1606
Mailing Address - Country:US
Mailing Address - Phone:812-734-6672
Mailing Address - Fax:
Practice Address - Street 1:150 N WACKER DR STE 1320
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60606-1606
Practice Address - Country:US
Practice Address - Phone:312-448-6647
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-03
Last Update Date:2023-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.0334331223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty