Individual
DR. LOUIS B. SCANNICCHIO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
110 N OAK PARK AVE, OAK PARK, IL 60301-1304
(708) 524-0101
(708) 524-0164
Mailing address
110 N OAK PARK AVE, OAK PARK, IL 60301-1304
(708) 524-0101
(708) 524-0164
Taxonomy
Speciality
Code
Description
License number
State
1223P0106X
Oral and Maxillofacial Pathology Dentistry
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10535
BCBS
IL
Enumeration date
02/01/2007
Last updated
07/08/2007
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