Individual
MIRA SUVAGIA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DMD, MS
Contact information
Practice address
1137 N PROSPECT AVE # C101, ITASCA, IL 60143-1437
(630) 338-7740
Mailing address
9N946 HEATHERINGTON PL, ELGIN, IL 60124-8351
(630) 338-7740
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
019.033765
IL
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
021.003389
IL
Other
Enumeration date
08/08/2024
Last updated
03/21/2025
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