Individual
DR. LISA MARIE BEAUDETTE-NGUYEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
2424 W. PETERSON AVE, CHICAGO, IL 60659
(773) 761-0300
(773) 761-0009
Mailing address
2424 W. PETERSON AVE, CHICAGO, IL 60659
(773) 761-0300
(773) 761-0009
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
019028277
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
019028277
—
IL
Enumeration date
05/27/2010
Last updated
01/31/2022
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