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Organization
RENOVATIO DENTAL, INC
Active
Organization
RENOVATIO DENTAL, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KHANH P NGUYEN D.D.S (PRESIDENT)
(312) 320-3268
Entity
Organization
Contact information
Practice address
212 E CULLERTON ST APT 712, CHICAGO, IL 60616-1293
(312) 320-3268
Mailing address
212 E CULLERTON ST APT 712, CHICAGO, IL 60616-1293
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
IL
Other
Enumeration date
05/04/2007
Last updated
08/22/2020
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