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General NPI Number Information
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NPI Number | 1124290671
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Entity Type | Individual
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Provider Name | MAGDALENO S NUCUM DDS
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Gender | Male
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Dates
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Enumeration Date | 03/25/2008
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Last Update Date | 03/25/2008
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Provider Practice Location Address
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Address Line | 287 N WEBER RD
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City | BOLINGBROOK
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State | IL
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Zip | 60490-1567
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Country | US
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Telephone | 630-226-9292
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Fax |
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Provider Business Mailing Address
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Address Line | 5101 N MULLIGAN AVE
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City | CHICAGO
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State | IL
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Zip | 60630-1812
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Country | US
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Telephone | 773-631-1794
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State | IL
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