Individual
MARY ELLEN MCCORMACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
711 W NORTH AVE, CHICAGO, IL 60610
(312) 944-0658
Mailing address
711 W NORTH AVE, CHICAGO, IL 60610
(312) 944-0531
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
019025128
IL
Other
Enumeration date
05/19/2008
Last updated
05/19/2008
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