Provider Demographics
NPI:1700920683
Name:SUGAR FIX
Entity Type:Organization
Organization Name:SUGAR FIX
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:T
Authorized Official - Last Name:EMERY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-883-1818
Mailing Address - Street 1:3346 N PAULINA ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-1038
Mailing Address - Country:US
Mailing Address - Phone:773-883-1818
Mailing Address - Fax:
Practice Address - Street 1:3346 N PAULINA ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-1038
Practice Address - Country:US
Practice Address - Phone:773-883-1818
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-16
Last Update Date:2008-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190263281223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty