Individual
JOSE MANUEL MARISCAL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
7124 W DIVERSEY AVE, CHICAGO, IL 60707-1601
(773) 237-8855
Mailing address
7124 W DIVERSEY AVE, CHICAGO, IL 60707-1601
(773) 237-8855
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
019.027908
IL
Other
Enumeration date
05/20/2009
Last updated
05/20/2009
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