Individual
KIMBERLY FASULA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RDH, MS, MPH
Contact information
Practice address
836 W WELLINGTON AVE, CHICAGO, IL 60657-5147
(773) 474-6896
Mailing address
3830 S LOWE AVE, CHICAGO, IL 60609-1645
(773) 474-6896
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
020009530
IL
Other
Enumeration date
12/09/2020
Last updated
12/09/2020
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