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General NPI Number Information
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NPI Number | 1346624624
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Entity Type | Organization
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Legal Business Name | METROPOLITAN DENTAL
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Dates
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Enumeration Date | 07/16/2015
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Last Update Date | 07/16/2015
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Provider Practice Location Address
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Address Line | 7034 CERMAK RD STE 3
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City | BERWYN
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State | IL
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Zip | 60402-2156
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Country | US
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Telephone | 630-890-1940
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Fax |
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Provider Business Mailing Address
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Address Line | 52 FALCON PL
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City | WESTMONT
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State | IL
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Zip | 60559-3217
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Country | US
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Telephone | 630-890-1940
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | DR. MICHAEL A AURIEMMA
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Credential | D.M.D
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Telephone | 630-890-1940
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 019030294
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License Number State | IL
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