| Llc | |
|
9714 Franklin Ave Franklin Park IL 60131-1787 | |
| (773) 732-3408 | |
| (773) 925-9289 |
| Full Name | Llc |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 9714 Franklin Ave, Franklin Park, Illinois |
| Authorized Official Name and Position | Victor Hugo Rendon (PRESIDENT) |
| Authorized Official Contact | 6309910437 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Llc 9714 Franklin Ave Franklin Park IL 60131-1787 Ph: (773) 732-3408 | Llc 9714 Franklin Ave Franklin Park IL 60131-1787 Ph: (773) 732-3408 |
| NPI Number | 1407087729 |
|---|---|
| Provider Enumeration Date | 08/04/2009 |
| Last Update Date | 08/04/2009 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1407087729 | NPI | - | NPPES |
| 9219530 | Medicaid | IL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | 019027752 (Illinois) | Primary |
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