Individual
DR. JOHN JOSEPH ILLUMINATI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
20 LONG CREEK DR, SOUTH PORTLAND, ME 04106
(207) 761-4010
Mailing address
20 LONG CREEK DR, SOUTH PORTLAND, ME 04106
(207) 761-4010
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
2953
ME
Other
Enumeration date
02/01/2008
Last updated
02/01/2008
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