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General NPI Number Information
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NPI Number | 1235340373
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Entity Type | Organization
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Legal Business Name | JOHN R. MARINUCCI, D.DS., LTD.
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Dates
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Enumeration Date | 05/24/2007
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Last Update Date | 02/07/2012
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Provider Practice Location Address
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Address Line | 414 DIXIE HWY
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City | CHICAGO HEIGHTS
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State | IL
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Zip | 60411-1739
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Country | US
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Telephone | 708-754-7505
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Fax | 708-754-5576
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Provider Business Mailing Address
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Address Line | 414 DIXIE HWY
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City | CHICAGO HEIGHTS
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State | IL
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Zip | 60411-1739
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Country | US
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Telephone | 708-754-7505
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Fax | 708-754-5576
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JOHN ROCCO MARINUCCI
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Credential | D.D.S.
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Telephone | 708-754-7505
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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 | 019013059
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License Number State | IL
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