Organization
F L M DENTAL CORP PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOSE MARISCAL (OWNER)
(773) 929-4140
Entity
Organization
Contact information
Practice address
3514 N LINCOLN AVE, CHICAGO, IL 60657-1104
(773) 929-4140
(773) 929-2514
Mailing address
3514 N LINCOLN AVE, CHICAGO, IL 60657-1104
(773) 929-4140
(773) 929-2514
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
019020112
IL
1223G0001X
General Practice Dentistry
019027020
IL
Other
Enumeration date
11/09/2006
Last updated
02/21/2018
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