Individual
MARIA S LARA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RDH
Contact information
Practice address
2424 W. PETERSON, CHICAGO, IL 60659
(773) 761-0300
(773) 761-0009
Mailing address
2424 W. PETERSON, CHICAGO, IL 60659
(773) 761-0300
(773) 761-0009
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
020.014789
IL
Other
Enumeration date
11/05/2014
Last updated
01/15/2019
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