MEDICARE: DR. JOHN GERARD MARCHESE D.D.S

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	019-020451	IL

General Provider Information

NPI Number	:	1073875357
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN GERARD MARCHESE D.D.S

Provider Business Mailing Address
First Line	:	5133 WASHINGTON ST
Second Line	:	SUITE 10
City	:	DOWNERS GROVE
State	:	IL
Zip	:	60515-4788
Country	:	US
Telephone Number	:	630-964-7852
Fax Number	:

Provider Business Practice Location Address
First Line	:	5133 WASHINGTON ST
Second Line	:	SUITE 10
City	:	DOWNERS GROVE
State	:	IL
Zip	:	60515-4788
Country	:	US
Telephone Number	:	630-964-7852
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/12/2012
Last Update Date	:	06/12/2012

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