Individual
EMANUEL EDWARDO DE LA FUENTE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
7310 WALTON ST, ROCKFORD, IL 61108-4614
(815) 395-5555
Mailing address
3632 S AUSTIN BLVD, CICERO, IL 60804-4150
(773) 969-9329
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
019.036286
IL
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
05/29/2025
Last updated
07/15/2025
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