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General NPI Number Information
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NPI Number | 1477409829
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Entity Type | Organization
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Legal Business Name | KINTSUGI GROUP PLLC
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Dates
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Enumeration Date | 03/09/2026
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Last Update Date | 03/09/2026
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Provider Practice Location Address
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Address Line | 1879 N MILWAUKEE AVE STE 1
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City | CHICAGO
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State | IL
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Zip | 60647-5689
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Country | US
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Telephone | 312-429-6506
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Fax |
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Provider Business Mailing Address
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Address Line | 1879 N MILWAUKEE AVE STE 1
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City | CHICAGO
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State | IL
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Zip | 60647-5689
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Country | US
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Telephone | 312-429-6506
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | LUIS PERALTA
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Credential | DMD
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Telephone | 917-742-4608
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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 |
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License Number State |
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