Provider Demographics
NPI:1245678473
Name:ADVANCED ENDODONTICS OF CHICAGO
Entity type:Organization
Organization Name:ADVANCED ENDODONTICS OF CHICAGO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MILTON
Authorized Official - Middle Name:L
Authorized Official - Last Name:DAVENPORT
Authorized Official - Suffix:III
Authorized Official - Credentials:DMD,PC
Authorized Official - Phone:312-291-9571
Mailing Address - Street 1:111 N WABASH AVE STE 812
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60602-1912
Mailing Address - Country:US
Mailing Address - Phone:312-291-9571
Mailing Address - Fax:312-291-9573
Practice Address - Street 1:111 N WABASH AVE STE 812
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60602-1912
Practice Address - Country:US
Practice Address - Phone:312-291-9571
Practice Address - Fax:312-291-9573
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-10
Last Update Date:2013-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0210022231223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty