Individual
DR. PHILIP MARK MUSSARI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
4725 W FULLERTON AVE, CHICAGO, IL 60639-1817
(773) 252-4240
Mailing address
5042 PRATT AVE, SKOKIE, IL 60077-3513
(847) 983-0748
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
019021820
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
019021820
DENTAL LICENCE NUMBER
IL
Enumeration date
08/17/2007
Last updated
08/17/2007
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