PHENNATDA POLPORNVITOON (NPI# 1568082030) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1568082030 |
| Entity Type | Individual |
| Full Name | PHENNATDA POLPORNVITOON |
| Practice Address |
801 S Paulina St Rm 110 Chicago IL 60612-7210 |
| Practice Telephone | 3129961052 |
| Mailing Telephone | 3129961052 |
| Enumeration Date | 2020-04-24 |
| Last Update Date | 2020-07-26 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223D0001X |
Dentist Specialization: Dental Public Health |
018.002156 | IL | Dental Providers |
| N | 390200000X | Student in an Organized Health Care Education/Training Program | Student, Health Care |
| Street Address |
801 S PAULINA ST RM 110 |
| City | CHICAGO |
| State | IL |
| Zip Code | 60612-7210 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1114248655 | Sloan Boyd Ashabranner | Dentist | 801 S Paulina St Rm 110, Chicago, IL 60612-7210 | 2010-06-18 |
| 1962021139 | Jordan Elmowitz | Dentist | 801 S Paulina St Rm 110, Chicago, IL 60612-7210 | 2020-04-08 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1144839739 | Sandhya Shri Kannayiram | Internal Medicine | 1901w Harrison Street, Chicago, IL 60612 | 2020-07-29 |
| 1568080174 | Nastaran Ordoyo Haghani Rad | Student in an Organized Health Care Education/Training Program | 1950 W. Polk Street, Room 6203, Chicago, IL 60612 | 2020-07-09 |
| 1669090403 | Marianne Gagnon-konamna | Student in an Organized Health Care Education/Training Program | 1950 West Polk Street, Chicago, IL 60612 | 2020-07-08 |
| 1922625672 | Tanya Montgomery Nee Brown | Pediatrics | 1950 West Polk Street, Neonatal and Perinatal Department, Chicago, IL 60612 | 2020-06-29 |
| 1124643028 | Ashley Swan | Dentist | 801 S. Paulina St, Uic College of Dentistry - Endodontics Clinic, Chicago, IL 60612 | 2020-06-16 |
| 1831711381 | Baillie Anne Bronner | Obstetrics & Gynecology | 1653 W Congress Pkwy Chicago, Il 60612, Chicago, IL 60612 | 2020-05-07 |
| 1154942449 | Keisha Davell Cole | Case Manager/Care Coordinator | 612 S Western Ave Unit 1, Chicago, IL 60612 | 2020-04-28 |
| 1275153777 | Isac Lim | Student in an Organized Health Care Education/Training Program | 1234 S. Wells, Chicago, IL 60612 | 2020-04-24 |
| 1578183414 | Zachary Belden | Student in an Organized Health Care Education/Training Program | Uic Psychiatry Residency 912 S. Wood St., Rm 130b Npi-s (mc 913), Chicago, IL 60612 | 2020-04-21 |
| 1548880560 | Christina Nunez | Student in an Organized Health Care Education/Training Program | 801 S. Paulina Street, M/c 850, Chicago, IL 60612 | 2020-04-20 |
| Find all providers in zip 60612 | ||||
| Taxonomy Code | 1223D0001X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | Dental Public Health |
| The science and art of preventing and controlling dental diseases and promoting dental health through organized community efforts. It is that form of dental practice that serves the community as a patient rather than the individual. It is concerned with the dental health education of the public, with applied dental research, and with the administration of group dental care programs as well as the prevention and control of dental diseases on a community basis. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1659821221 | Tca Health Care | Dentist | 1030 E. 130th St, Chicago, IL 60628 | 2016-10-07 |
| 1386824498 | Manus Health Systems | Dentist | 676 N Michigan Ave Ste 3500, Chicago, IL 60611-2839 | 2007-11-06 |
| 1083768113 | Philip Nelson | Dentist | 6124 N Overhill Ave, Chicago, IL 60631-3817 | 2007-01-23 |
| 1518956978 | Trina Marie Blunt | Dentist | 8100 S Luella Ave, Chicago, IL 60617-1152 | 2005-10-18 |
| 1114920964 | Steven Patrick Geiermann | Dentist | 5218 N Winthrop Ave, # 3n, Chicago, IL 60640-2306 | 2005-05-24 |
| 1841785375 | Jeffrey S Wittmus Dds Ltd | Dentist | 5315 N Central Ave, Chicago, IL 60630-1302 | 2018-06-27 |
| 1023526852 | All Perfect Smiles of Beverly PC | Dentist | 10601 S Western Ave, Chicago, IL 60643-3100 | 2018-01-15 |
| 1992225627 | Susan Sunok Singer | Dentist | 2632 W Division St, Chicago, IL 60622-2850 | 2017-06-23 |
| 1689103228 | Alexis Linnebur | Dentist | 201 E Huron St, Chicago, IL 60611 | 2017-06-07 |
| 1346534740 | Albert Vo | Dentist | 9119 S Exchange Ave, Chicago, IL 60617-4225 | 2011-06-02 |
| Find all providers in CHICAGO | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.