Individual
DR. FRED J DE LA COTERA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
7714 W NORTH AVE, ELMWOOD PARK, IL 60707-4123
(708) 456-7282
(708) 456-7296
Mailing address
7714 W NORTH AVE, ELMWOOD PARK, IL 60707-4123
(708) 203-4095
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
021-001570
IL
Other
Enumeration date
01/19/2006
Last updated
01/11/2024
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