Individual
DR. MARK L TANNENBAUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
5307 W 79TH ST, BURBANK, IL 60459-1403
(708) 424-5650
Mailing address
5307 W 79TH ST, BURBANK, IL 60459-1403
(708) 424-5650
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
19015293
IL
Other
Enumeration date
11/28/2006
Last updated
07/08/2007
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