Organization Name: | DURAES JHAM DENTAL, P.C |
NPI Number: | 1104260884 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | GABRIELA DURAES (PRESIDENT) |
Mailing Address: | 156a East Lake Street Bloomingdale |
State: | IL US |
Postal Code: | 601081263 |
Phone Number: | 7088343602 |
Fax Number: | |
NPI Enumeration Date: | 04/24/2013 |
NPI Last Update Date: | 04/24/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QD0000X |
License Number: | 019028921 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IL |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Dental |
Taxonomy Definition: |