Individual
DR. MARILYS VALCOURT EWA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS, MPH
Contact information
Practice address
2917 W 63RD ST, CHICAGO, IL 60629-2729
(773) 476-8217
(773) 476-8251
Mailing address
2917 W 63RD ST, CHICAGO, IL 60629-2729
(773) 476-8217
(773) 476-8251
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0000779
DENTAL NETWORK OF AMERICA
IL
01
—
001075
COMPDENT
IL
01
—
013043
FIRST COMMONWEALTH
IL
05
—
1001783
—
IL
01
—
158077525126
HUMANA TDC
IL
Enumeration date
06/15/2007
Last updated
07/08/2007
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