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General NPI Number Information
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NPI Number | 1407087729
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Entity Type | Organization
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Legal Business Name | SEMPER DENTAL CENTER LLC
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Dates
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Enumeration Date | 08/04/2009
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Last Update Date | 08/04/2009
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Provider Practice Location Address
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Address Line | 9714 FRANKLIN AVE
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City | FRANKLIN PARK
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State | IL
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Zip | 60131-1787
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Country | US
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Telephone | 773-732-3408
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Fax | 773-925-9289
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Provider Business Mailing Address
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Address Line | 9714 FRANKLIN AVE
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City | FRANKLIN PARK
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State | IL
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Zip | 60131-1787
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Country | US
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Telephone | 773-732-3408
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Fax | 773-925-9289
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. VICTOR HUGO RENDON JR.
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Credential | DDS
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Telephone | 630-991-0437
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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 | 019027752
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License Number State | IL
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