Provider Demographics
NPI:1952781916
Name:UNIVERSITY OF ILLINOIS AT CHICAGO COLLEGE OF DENTISTRY
Entity Type:Organization
Organization Name:UNIVERSITY OF ILLINOIS AT CHICAGO COLLEGE OF DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHAIRMAN, DEPT. OF PERIODONTOLOGY
Authorized Official - Prefix:DR
Authorized Official - First Name:SAVALDOR
Authorized Official - Middle Name:
Authorized Official - Last Name:NARES
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS, PHD
Authorized Official - Phone:312-413-4467
Mailing Address - Street 1:1201 S PRAIRIE AVE
Mailing Address - Street 2:4901
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60605-3325
Mailing Address - Country:US
Mailing Address - Phone:312-522-8417
Mailing Address - Fax:
Practice Address - Street 1:801 S PAULINA ST
Practice Address - Street 2:465B
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-7210
Practice Address - Country:US
Practice Address - Phone:312-355-4819
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-04
Last Update Date:2015-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.0297691223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty