Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | IL |
NPI | 1083763965 |
---|---|
Provider Name | Dr. Dorothy Anna Anasinski |
First Address | Niles, IL 60714-2723 |
Second Address | Niles, IL 60714-2723 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/01/2007 |
Last Update Date | 08/07/2007 |