Individual
AMMIE LUCERO CHINCHILLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1740 W TAYLOR ST, CHICAGO, IL 60612-7232
(866) 600-2273
Mailing address
900 S CLARK ST APT 904, CHICAGO, IL 60605-3686
(702) 465-3399
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
019.034006
IL
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/08/2021
Last updated
05/11/2023
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