# DENTAL DIAGNOSTIC IMAGING

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1942653738
- **Authorized official:** DR. MITRA SADRAMELI DMD, MS (PRESIDENT)
- **Authorized official phone:** (312) 966-6307

## Contact information

- **Practice address:** 1201 S PRAIRIE AVE, 4901, CHICAGO, IL 60605-3325
- **Practice address phone:** (312) 966-6307
- **Mailing address:** 1201 S PRAIRIE AVE, 4901, CHICAGO, IL 60605-3325
- **Mailing address phone:** (312) 966-6307

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223X0008X | Oral and Maxillofacial Radiology Dentistry | 019.030434 | IL | Yes |

## Other

- **Enumeration date:** 07/18/2016
- **Last updated:** 07/18/2016