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General NPI Number Information
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NPI Number | 1518191295
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Entity Type | Organization
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Legal Business Name | POWELL AND MARTELLO P.C.
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Dates
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Enumeration Date | 05/08/2009
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Last Update Date | 05/08/2009
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Provider Practice Location Address
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Address Line | 10241 W LINCOLN HWY
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City | FRANKFORT
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State | IL
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Zip | 60423-1279
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Country | US
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Telephone | 815-464-6500
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Fax | 815-464-6503
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Provider Business Mailing Address
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Address Line | 10241 W LINCOLN HWY
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City | FRANKFORT
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State | IL
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Zip | 60423-1279
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Country | US
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Telephone | 815-464-6500
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Fax | 815-464-6503
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. CHRISTOPHER THOMAS POWELL
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Credential | DDS
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Telephone | 815-464-6500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 021001750
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 021001487
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 021002201
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License Number State |
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