Individual
DR. FELICIA S MATA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DMD
Contact information
Practice address
30 N MICHIGAN AVE, SUITE 822, CHICAGO, IL 60602-3402
(312) 263-6793
(312) 263-0906
Mailing address
30 N MICHIGAN AVE, SUITE 822, CHICAGO, IL 60602-3402
(312) 263-6793
(312) 263-0906
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
019024302
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1417034851
DENTAL
IL
Enumeration date
10/23/2008
Last updated
08/20/2016
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