Provider Demographics
NPI:1912159534
Name:NESSIM, INGY MOURICE (DDS)
Entity Type:Individual
Prefix:DR
First Name:INGY
Middle Name:MOURICE
Last Name:NESSIM
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 1:1634 E 53RD ST
Mailing Address - Street 2:#101
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60615-4384
Mailing Address - Country:US
Mailing Address - Phone:773-752-5677
Mailing Address - Fax:
Practice Address - Street 1:1634 E 53RD ST
Practice Address - Street 2:#101
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60615-4384
Practice Address - Country:US
Practice Address - Phone:773-752-5677
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-14
Last Update Date:2009-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.027737122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist