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Organization
SAM DAUAHERA DDS PC
Active
Organization
SAM DAUAHERA DDS PC
Active
Other names
Edgebrook Dental Associates
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SAM DAUAHERA DDS (OWNER)
(773) 456-5659
Entity
Organization
Contact information
Practice address
5131 W DEVON AVE, CHICAGO, IL 60646-4217
(773) 631-8717
(773) 631-7781
Mailing address
5131 W DEVON AVE, CHICAGO, IL 60646-4217
(773) 631-8717
(773) 631-7781
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
019027577
IL
Other
Enumeration date
03/12/2013
Last updated
03/12/2013
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