Provider Demographics
NPI:1538717327
Name:LA, ANH SOH (DDS)
Entity type:Individual
Prefix:
First Name:ANH
Middle Name:SOH
Last Name:LA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:ANH
Other - Middle Name:LA
Other - Last Name:WINFIELD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:3351 W ADAMS ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60624-2904
Mailing Address - Country:US
Mailing Address - Phone:415-760-1776
Mailing Address - Fax:
Practice Address - Street 1:5635 W BELMONT AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60634-4384
Practice Address - Country:US
Practice Address - Phone:773-736-1830
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-27
Last Update Date:2019-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.032367122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist