Provider Demographics
NPI:1366717464
Name:CHOLAKIAN, SUSAN M (DDS)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:M
Last Name:CHOLAKIAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1585 ELLINWOOD AVE
Mailing Address - Street 2:SUITE 106
Mailing Address - City:DES PLAINES
Mailing Address - State:IL
Mailing Address - Zip Code:60016-4510
Mailing Address - Country:US
Mailing Address - Phone:847-803-5151
Mailing Address - Fax:847-803-5491
Practice Address - Street 1:1585 ELLINWOOD AVE
Practice Address - Street 2:SUITE 106
Practice Address - City:DES PLAINES
Practice Address - State:IL
Practice Address - Zip Code:60016-4510
Practice Address - Country:US
Practice Address - Phone:847-803-5151
Practice Address - Fax:847-803-5491
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-21
Last Update Date:2012-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190208521223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice