F L M Dental Corp PC
Dentist, General Practice in Chicago, IL. Organization (NPI-2).
NPI number1235209727
StatusActive
Last updated in NPPESFeb 21, 2018
Details
- NPI
- 1235209727
- Entity type
- Organization (NPI-2)
- Legal business name
- F L M Dental Corp PC
- Organization subpart
- No
- Enumeration date
- Nov 9, 2006
- Last updated
- Feb 21, 2018
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 1223G0001X | Dentist, General Practice | 019020112 | IL | Yes |
| 1223G0001X | Dentist, General Practice | 019027020 | IL |
Practice location
3514 N Lincoln AveChicago, IL 60657-1104
Phone 773-929-4140 · Fax 773-929-2514
Mailing address
3514 N Lincoln AveChicago, IL 60657-1104
Phone 773-929-4140 · Fax 773-929-2514
Authorized official
Jose Mariscal
Owner
7739294140
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