Most Relevant Information
Provider Data
| NPI Number: | 1003047929 |
| Provider Name: | SODABEH ETMINAN DMD |
| Entity Type: | Individual |
| Taxonomy Code: | 1223G0001X |
| Specialty: | Dentist |
| License Number: | 019.027979 |
Most Important Dates
| Enumeration Date: | 07/28/2009 |
| Last Updated: | 09/28/2016 |
Provider Practice Location
7131 S JEFFERY BLVD STE A
CHICAGO
IL
606492176
Practice Location Phone/Fax
| Phone: | 7732560526 |
| Fax: |
Provider Mailing Location
1220 S WOOD ST
CHICAGO
IL
606081202
Provider Mailing Phone/Fax
| Phone: | 3124131789 |
| Fax: |