Provider Demographics
NPI:1154802130
Name:TEETH MATTER INC.
Entity type:Organization
Organization Name:TEETH MATTER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:DR. EVA
Authorized Official - Middle Name:
Authorized Official - Last Name:BLODA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:773-622-7773
Mailing Address - Street 1:1658 N MILWAUKEE AVE
Mailing Address - Street 2:SUITE 395 ATTN: W SALIH
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60647
Mailing Address - Country:US
Mailing Address - Phone:773-622-7773
Mailing Address - Fax:773-286-6767
Practice Address - Street 1:6418 W BELMONT AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60634-4099
Practice Address - Country:US
Practice Address - Phone:773-916-2500
Practice Address - Fax:773-337-0731
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-27
Last Update Date:2018-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty