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General NPI Number Information
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NPI Number | 1497811236
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Entity Type | Individual
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Provider Name | PETER M TOMASELLI DDS,FICOI,FACE,FDOCS
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Gender | Male
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Dates
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Enumeration Date | 12/28/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 437 W NORTH AVE
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City | CHICAGO
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State | IL
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Zip | 60610-1420
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Country | US
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Telephone | 312-664-2100
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Fax | 312-664-0234
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Provider Business Mailing Address
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Address Line | 437 W NORTH AVE
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City | CHICAGO
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State | IL
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Zip | 60610-1420
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Country | US
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Telephone | 312-664-2100
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Fax | 312-664-0234
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 |
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License Number State | IL
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