Provider Demographics
NPI:1861887036
Name:ROBERT L NEEMS DDS PC
Entity type:Organization
Organization Name:ROBERT L NEEMS DDS PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:L
Authorized Official - Last Name:NEEMS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:773-588-7840
Mailing Address - Street 1:1945 W WILSON AVE
Mailing Address - Street 2:SUITE 5117
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640-5255
Mailing Address - Country:US
Mailing Address - Phone:773-588-7840
Mailing Address - Fax:773-588-0711
Practice Address - Street 1:1945 W WILSON AVE
Practice Address - Street 2:SUITE 5117
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640-5255
Practice Address - Country:US
Practice Address - Phone:773-588-7840
Practice Address - Fax:773-588-0711
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-03
Last Update Date:2015-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019019466122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty