T Marie PC
Dentist in Evanston, IL. Organization (NPI-2).
NPI number1447584560
StatusActive
Last updated in NPPESSep 22, 2009
Details
- NPI
- 1447584560
- Entity type
- Organization (NPI-2)
- Legal business name
- T Marie PC
- Organization subpart
- No
- Enumeration date
- Sep 22, 2009
- Last updated
- Sep 22, 2009
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 122300000X | Dentist | 019026504 | IL | Yes |
Practice location
1029 Howard StEvanston, IL 60202-3877
Phone 847-491-0660
Mailing address
8100 S Luella AveChicago, IL 60617-1152
Authorized official
Trina Blunt
Dentist
7738277874
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