Provider Demographics
NPI:1215155478
Name:EGAN-KRAMER, MARY ANN (BSN,DDS)
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:ANN
Last Name:EGAN-KRAMER
Suffix:
Gender:F
Credentials:BSN,DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:917 S KNIGHT AVE
Mailing Address - Street 2:
Mailing Address - City:PARK RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60068-4442
Mailing Address - Country:US
Mailing Address - Phone:847-825-0736
Mailing Address - Fax:
Practice Address - Street 1:120 OAKBROOK CTR STE 326
Practice Address - Street 2:
Practice Address - City:OAK BROOK
Practice Address - State:IL
Practice Address - Zip Code:60523-4726
Practice Address - Country:US
Practice Address - Phone:630-990-7766
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019019251122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist