Basic Information
| Provider Information | |||||||||
| NPI: | 1235372947 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NGO | ||||||||
| FirstName: | NANCY | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | DDS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 505 N LAKE SHORE DR APT 2611 | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606116419 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4108148226 | ||||||||
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| Practice Location | |||||||||
| Address1: | 200 W. LAKE STREET | ||||||||
| Address2: | |||||||||
| City: | ADDISON | ||||||||
| State: | IL | ||||||||
| PostalCode: | 60101 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8889884066 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/10/2009 | ||||||||
| LastUpdateDate: | 04/10/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 122300000X | DS 037307 | PA | N | Dental Providers | Dentist | 122300000X | 019.027874 | IL | Y | Dental Providers | Dentist |
No ID Information.