Individual
DR. KENNY MATEE GOMOLPLITINANT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.M.D.
Contact information
Practice address
413 W SAINT CHARLES RD, VILLA PARK, IL 60181-2432
(630) 629-3120
Mailing address
413 W SAINT CHARLES RD, VILLA PARK, IL 60181-2432
(630) 629-3120
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
019030276
IL
122300000X
Dentist
319019495
IL
Other
Enumeration date
07/13/2015
Last updated
07/07/2021
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