Provider Demographics
NPI:1912255910
Name:NUNNEY, ANDREA VENIZELOS (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:VENIZELOS
Last Name:NUNNEY
Suffix:
Gender:F
Credentials:DDS, MS
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:
Other - Last Name:VENIZELOS-NUNNEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1234 N WOLCOTT AVE
Mailing Address - Street 2:APT 1
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60622-3882
Mailing Address - Country:US
Mailing Address - Phone:216-470-7767
Mailing Address - Fax:
Practice Address - Street 1:801 S PAULINA ST
Practice Address - Street 2:ROOM 304 G
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-7210
Practice Address - Country:US
Practice Address - Phone:312-996-7514
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-22
Last Update Date:2012-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.029185122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist