Provider Demographics
NPI:1699973636
Name:MODARRESSI, MARMAR (DDS, MS)
Entity type:Individual
Prefix:DR
First Name:MARMAR
Middle Name:
Last Name:MODARRESSI
Suffix:
Gender:F
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:845 N MICHIGAN AVE STE 940W
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-2216
Mailing Address - Country:US
Mailing Address - Phone:312-751-1020
Mailing Address - Fax:312-751-1231
Practice Address - Street 1:845 N MICHIGAN AVE STE 940W
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-2216
Practice Address - Country:US
Practice Address - Phone:312-751-1020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-10
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.0282051223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics