Provider Demographics
NPI:1720849995
Name:ASTACIO, EVA (RDH)
Entity Type:Individual
Prefix:MRS
First Name:EVA
Middle Name:
Last Name:ASTACIO
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:947 N LATROBE AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60651-2962
Mailing Address - Country:US
Mailing Address - Phone:872-305-7954
Mailing Address - Fax:
Practice Address - Street 1:1520 N KOSTNER AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60651-1610
Practice Address - Country:US
Practice Address - Phone:312-216-8020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-16
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL020.017876124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist