Organization
DENTAL DIAGNOSTIC IMAGING
Active
Organization
DENTAL DIAGNOSTIC IMAGING
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MITRA SADRAMELI DMD, MS (PRESIDENT)
(312) 966-6307
Entity
Organization
Contact information
Practice address
1201 S PRAIRIE AVE, 4901, CHICAGO, IL 60605-3325
(312) 966-6307
Mailing address
1201 S PRAIRIE AVE, 4901, CHICAGO, IL 60605-3325
(312) 966-6307
Taxonomy
Speciality
Code
Description
License number
State
1223X0008X
Oral and Maxillofacial Radiology Dentistry
Primary
019.030434
IL
Other
Enumeration date
07/18/2016
Last updated
07/18/2016
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