Organization
JASON DIFANI, DDS, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JASON T DIFANI DDS (OWNER)
(309) 824-8835
Entity
Organization
Contact information
Practice address
5050 S KEDZIE AVE UNIT A, CHICAGO, IL 60632-3009
(773) 778-2200
(773) 778-2202
Mailing address
1843 W ROSCOE ST APT 1, CHICAGO, IL 60657-1102
(309) 824-8835
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
019027928
IL
Other
Enumeration date
06/20/2011
Last updated
06/20/2011
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