Individual
DR. RUSSELL P PESAVENTO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
1118 N LARKIN AVE, JOLIET, IL 60435-3456
(815) 714-2271
Mailing address
1118 N LARKIN AVE, JOLIET, IL 60435-3456
(815) 714-2271
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
019.030884
IL
Other
Enumeration date
03/20/2017
Last updated
03/20/2017
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