Provider Demographics
NPI:1396157848
Name:ARRUDA, ANA LUIZA (DMD, MSD)
Entity type:Individual
Prefix:
First Name:ANA LUIZA
Middle Name:
Last Name:ARRUDA
Suffix:
Gender:F
Credentials:DMD, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1229 W WASHINGTON BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60607-2132
Mailing Address - Country:US
Mailing Address - Phone:872-222-9567
Mailing Address - Fax:
Practice Address - Street 1:1229 W WASHINGTON BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60607-2132
Practice Address - Country:US
Practice Address - Phone:872-222-9567
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-02
Last Update Date:2016-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0210027321223X0400X
MO2014015504122300000X
IL019030520122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
No122300000XDental ProvidersDentist