Individual
LOIDA TICZON PREZA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DMD
Contact information
Practice address
5214 N WESTERN AVE, SUITE 303, CHICAGO, IL 60625-2589
(773) 769-8195
Mailing address
5214 N WESTERN AVE, SUITE 303, CHICAGO, IL 60625-2589
(773) 769-8195
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
019-022955
IL
Other
Enumeration date
05/14/2012
Last updated
05/14/2012
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