Individual
LUIS ANDRE MENDONCA MEZZOMO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DR.
Contact information
Practice address
801 S PAULINA ST, CHICAGO, IL 60612-7210
(312) 342-6140
Mailing address
939 W WASHINGTON BLVD APT W709, CHICAGO, IL 60607-2263
(312) 342-6140
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
136000272
IL
1223P0700X
Prosthodontics
136000272
IL
Other
Enumeration date
02/14/2024
Last updated
02/16/2024
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