Organization
EVANSTON PERIODONTICS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ROGER ALBERT NOUNEH DMD; MS (MANAGING MEMBER)
(312) 927-8882
Entity
Organization
Contact information
Practice address
636 CHURCH ST, SUITE # 722, EVANSTON, IL 60201-4508
(847) 475-7754
(847) 475-4725
Mailing address
636 CHURCH ST, SUITE # 722, EVANSTON, IL 60201-4508
(847) 475-7754
(847) 475-4725
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
Primary
—
IL
Other
Enumeration date
07/16/2006
Last updated
08/22/2020
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