Individual
ROBERT NIDEA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
16280 PRINCE DR, SOUTH HOLLAND, IL 60473-3233
(708) 225-1866
Mailing address
733 S HILLSIDE AVE, ELMHURST, IL 60126-4719
(210) 845-5879
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
019-022446
IL
1223G0001X
General Practice Dentistry
22529
TX
Other
Enumeration date
12/11/2006
Last updated
08/16/2016
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