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General NPI Number Information
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NPI Number | 1366699142
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Entity Type | Organization
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Legal Business Name | JOHN A. MARSALA D.D.S. ; LTD
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Dates
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Enumeration Date | 08/22/2008
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Last Update Date | 11/30/2009
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Provider Practice Location Address
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Address Line | 8225 GRAND AVE
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City | RIVER GROVE
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State | IL
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Zip | 60171-1517
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Country | US
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Telephone | 630-310-4897
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Fax |
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Provider Business Mailing Address
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Address Line | 8225 GRAND AVE
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City | RIVER GROVE
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State | IL
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Zip | 60171-1517
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Country | US
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Telephone | 630-310-4897
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JOHN A MARSALA
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Credential | D.D.S.
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Telephone | 630-310-4897
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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 | 19-18724
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License Number State | IL
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