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General NPI Number Information
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NPI Number | 1164719944
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Entity Type | Organization
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Legal Business Name | TRIPLEDOC CORP
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Dates
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Enumeration Date | 06/30/2011
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Last Update Date | 06/30/2011
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Provider Practice Location Address
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Address Line | 8524 W LAWRENCE AVE
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City | NORRIDGE
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State | IL
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Zip | 60706-2956
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Country | US
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Telephone | 708-456-0800
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Fax | 708-456-8889
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Provider Business Mailing Address
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Address Line | 8524 W LAWRENCE AVE
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City | NORRIDGE
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State | IL
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Zip | 60706-2956
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Country | US
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Telephone | 708-456-0800
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Fax | 708-456-8889
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Authorized Official
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Title or Position | D.D.S.
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Name | SALVATORE STORNIOLO
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Credential |
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Telephone | 708-456-0800
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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 | 019020586
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License Number State | IL
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