Dr. Clarissa Couch
Dentist Dental Public Health
10220 S 76th Ave Suite 250
Bridgeview
, Illinois 60455-2425
Dr. Clarissa Couch
Dentist Dental Public Health
10220 S 76th Ave Suite 250
Bridgeview
, Illinois 60455-2425
(312) 572-4788
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About
Features
Specialties
- Dentist
- Dental Public Health
Languages spoken
- English
Location
First Address
- Dr. Clarissa Couch
- 2020w Harrison St
- Chicago, IL
- Zip : 60612-3741
- Phone : (312) 572-4788
Second Address
- Dr. Clarissa Couch
- 10220 S 76th Ave Suite 250
- Bridgeview, IL
- Zip : 60455-2425
- Phone : (708) 974-6160
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| Y | 122300000X | Dentist | 019-022817 | IL |
| N | 1223D0001X | Dental Public Health | 019022817 | IL |
National Provider Identifier
| NPI | 1447388764 |
|---|---|
| Provider Name | Dr. Clarissa Couch |
| First Address | Chicago, IL 60612-3741 |
| Second Address | Bridgeview, IL 60455-2425 |
| Gender | F |
| NPI Entity type | Individual |
| Is Sole Proprietor | No |
| Is Organization Subpart | N/A |
| Enumeration Date | 28/02/2007 |
| Last Update Date | 22/04/2021 |
Additional Identifiers
| IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
|---|---|---|
| 101942 | TIN (01) | IL |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.