Provider Demographics
NPI:1720446842
Name:EMILY TANEVA DDS MS PC
Entity Type:Organization
Organization Name:EMILY TANEVA DDS MS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EMILIYA
Authorized Official - Middle Name:
Authorized Official - Last Name:TANEVA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-504-7972
Mailing Address - Street 1:73 E LAKE ST APT 3508
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60601-4800
Mailing Address - Country:US
Mailing Address - Phone:312-504-7972
Mailing Address - Fax:
Practice Address - Street 1:73 E LAKE ST APT 3508
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60601-4800
Practice Address - Country:US
Practice Address - Phone:312-504-7972
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-03
Last Update Date:2016-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL019029752Medicaid