Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | 019.031525 | IL |
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 021.003043 | IL |
NPI | 1043674021 |
---|---|
Provider Name | Andrew Sugar |
First Address | Elk Grove Village, IL 60007-3371 |
Second Address | Elk Grove Village, IL 60007-3371 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/04/2016 |
Last Update Date | 03/07/2020 |