Individual
LAURA SOFIA PESQUERA COLOM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DMD
Contact information
Practice address
801 S PAULINA ST, CHICAGO, IL 60612-7210
(312) 996-7555
Mailing address
447 N CARPENTER ST UNIT 3F, CHICAGO, IL 60642-6568
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
07/07/2023
Last updated
07/07/2023
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