Healthcare Provider Details

I. General information

NPI: 1578543245
Provider Name (Legal Business Name): HUGH MARCHMONT-ROBINSON DDS SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/19/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3302 SOUTH GROVE
BERWYN IL
60402
US

IV. Provider business mailing address

3302 SOUTH GROVE
BERWYN IL
60402
US

V. Phone/Fax

Practice location:
  • Phone: 708-788-8200
  • Fax: 708-795-8997
Mailing address:
  • Phone: 708-788-8200
  • Fax: 708-795-8997

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number StateIL

VIII. Authorized Official

Name: HUGH MARCHMONT-ROBINSON
Title or Position: OWNER
Credential: DDS
Phone: 708-788-8200