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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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