Individual
MR. PATRICK KEONE MIYAMASU
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
3210 W 63RD ST, CHICAGO, IL 60629-3325
(773) 776-8300
Mailing address
3210 W 63RD ST, CHICAGO, IL 60629-3325
(773) 776-8300
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
019028007
IL
Other
Enumeration date
06/29/2009
Last updated
06/29/2009
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