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General NPI Number Information
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NPI Number | 1356225973
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Entity Type | Organization
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Legal Business Name | KENNY A ROBLES GONZALEZ DDS PC
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Dates
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Enumeration Date | 08/05/2025
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Last Update Date | 08/05/2025
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Provider Practice Location Address
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Address Line | 3253 S HARLEM AVE UNIT 1C
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City | BERWYN
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State | IL
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Zip | 60402-2996
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Country | US
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Telephone | 708-788-4444
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Fax |
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Provider Business Mailing Address
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Address Line | 3253 S HARLEM AVE UNIT 1C
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City | BERWYN
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State | IL
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Zip | 60402-2996
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Country | US
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Telephone | 708-788-4444
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Fax | 708-788-4474
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. KENNY A ROBLES GONZALEZ
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Credential | DDS
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Telephone | 708-788-4444
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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