Individual
DR. GIANCARLO MALDONADO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
3622 W 26TH ST, CHICAGO, IL 60623-3936
(773) 522-5252
(773) 522-0509
Mailing address
1520 CRAB TREE DR, WESTMONT, IL 60559-3466
(630) 965-6326
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
019-026594
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1437309945
TYPE 2 NPI
IL
Enumeration date
10/29/2008
Last updated
10/29/2008
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