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NPI Code Detail

MEDICARE: BLANCA MURILLO DDS

MEDICARE: BLANCA MURILLO DDS
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
1122300000XDentist019025678IL

General Provider Information

NPI Number : 1093968869
Entity Type Code : Organization
Provider Name (Legal Business Name) : BLANCA MURILLO DDS
Provider Business Mailing Address
First Line : 4634 S HERMITAGE AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60609-3831
Country : US
Telephone Number : 773-544-1664
Fax Number :
Provider Business Practice Location Address
First Line : 3939 W FULLERTON AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60647-2243
Country : US
Telephone Number : 773-235-0000
Fax Number :
Authorized Official
Title or Position : DENTIST
Name : DR. BLANCA ESTELA MURILLO
Credential : DDS
Telephone Number : 773-544-1664
Provider Enumeration Date : 10/24/2008
Last Update Date : 10/24/2008

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Directions to “BLANCA MURILLO DDS ” Practice Location

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