Organization
JOHN PETRUCCI DDS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOHN PETRUCCI DDS (OWNER)
(630) 924-5579
Entity
Organization
Contact information
Practice address
328 E ARMY TRAIL RD, GLENDALE HTS, IL 60139
(630) 924-5579
Mailing address
328 E ARMY TRAIL RD, GLENDALE HTS, IL 60139
(630) 924-5579
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
019019714
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
019019714
—
IL
Enumeration date
05/19/2008
Last updated
05/19/2008
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