| None | |
|
414 Dixie Hwy Chicago Heights IL 60411-1739 | |
| (708) 754-7505 | |
| (708) 754-5576 |
| Full Name | None |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 414 Dixie Hwy, Chicago Heights, Illinois |
| Authorized Official Name and Position | John Rocco Marinucci (PRESIDENT) |
| Authorized Official Contact | 7087547505 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| None 414 Dixie Hwy Chicago Heights IL 60411-1739 Ph: (708) 754-7505 | None 414 Dixie Hwy Chicago Heights IL 60411-1739 Ph: (708) 754-7505 |
| NPI Number | 1235340373 |
|---|---|
| Provider Enumeration Date | 05/24/2007 |
| Last Update Date | 02/07/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1235340373 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 019013059 (Illinois) | Primary |
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