CROWN JEWEL DENTAL LOFT – NPI #1811501570
Clinic/Center

CROWN JEWEL DENTAL LOFT is an AHC clinic located in CHICAGO, IL. NPPES has assigned the NPI number 1811501570 to CROWN JEWEL DENTAL LOFT on September 01, 2020. It is a Type-2 NPI, indicating this NPI number is associated with an organization. Since the name “CROWN JEWEL DENTAL LOFT” is a dba name, the actual legal business name for this organization is ANDREA N. SIDLE DDS PC. The primary taxonomy selected by this provider is 261QD0000X from the Health Care Provider Taxonomy code set, which is classified as Clinic/Center, specializing in Dental

The NPI profile was previously updated about 5 years ago on Aug 09, 2021. Use the NPI data found here to bill health insurance companies, identify providers enrolled in Medicare and Medicaid services or other HIPAA compliant transactions. See the complete NPI profile for CROWN JEWEL DENTAL LOFT below.

NPI Profile for
ANDREA N. SIDLE DDS PC

NPI Number
1811501570
Enumeration Date

(about 6 years ago)
Entity Type
Type-2  Organization
Organization health care providers may have a single employee or thousands of employees. An example is an incorporated individual who is an organization's only employee.
Legal Name
ANDREA N. SIDLE DDS PC
Doing Business As (dba): CROWN JEWEL DENTAL LOFT
Primary location
840 W IRVING PARK RD STE 407
CHICAGO, IL 60613-3011
Phone: (773) 248-8581 Fax:
1 Other location(s):
2200 N Halsted St
Chicago, IL 60614-3625
Phone: (773) 935-4444
Mailing address
Same as primary location
Organization Subpart
No
Authorized Official
ANDREA SIDLE
DDS
Phone: (816) 215-2904
Updated
Certification Date
Aug 09, 2021

Note: NPPES allows providers to attest to the accuracy of their NPI data. When a provider request any change to the NPI record, they will be able to attest to their changed NPI data, resulting in an updated certification date.

Taxonomy Code(s)

A taxonomy code is a code that describes the health care service provider's type, classification, and the area of specialization. The primary specialty for this provider is indicated as (Primary) below.

Taxonomy Classification / Specialization State License
261QD0000X
- Clinic/Center / Dental (Primary)

The taxonomy codes are selected by the provider at the time of NPI registration. Selection of a taxonomy code does not replace any credentialing or validation process that the provider requesting the code should complete.