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General NPI Number Information
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NPI Number | 1558898312
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Entity Type | Organization
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Legal Business Name | REM DDS INC
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Dates
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Enumeration Date | 05/11/2017
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Last Update Date | 11/09/2017
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Provider Practice Location Address
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Address Line | 2380 S ELMHURST RD SUITE 100
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City | MT PROSPECT
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State | IL
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Zip | 60056-5805
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Country | US
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Telephone | 224-634-1907
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Fax |
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Provider Business Mailing Address
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Address Line | 2380 S ELMHURST RD SUITE 100
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City | MT PROSPECT
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State | IL
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Zip | 60056-5805
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DDS
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Name | ROBERTO MONTEAGUDO
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Credential |
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Telephone | 402-932-9413
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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 | 019.031022
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License Number State | IL
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