Individual
DR. IRENE T. THEODORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
4200 W PETERSON AVE, SUITE 136, CHICAGO, IL 60646-6074
(773) 286-5286
(773) 286-5331
Mailing address
4200 W PETERSON AVE, SUITE 136, CHICAGO, IL 60646-6074
(773) 286-5286
(773) 286-5331
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
019020903
IL
Other
Enumeration date
07/09/2008
Last updated
07/17/2008
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