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General NPI Number Information
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NPI Number | 1821725839
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Entity Type | Individual
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Provider Name | DOMINIQUE ERICA BERTUCCI DMD
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Gender | Female
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Dates
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Enumeration Date | 08/01/2022
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Last Update Date | 04/22/2025
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Provider Practice Location Address
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Address Line | 737 N MICHIGAN AVE STE 1330
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City | CHICAGO
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State | IL
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Zip | 60611-5401
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Country | US
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Telephone | 312-266-8198
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Fax |
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Provider Business Mailing Address
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Address Line | 3349 S PARNELL AVE
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City | CHICAGO
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State | IL
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Zip | 60616-3517
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Country | US
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Telephone | 312-607-1029
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Fax |
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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 | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 019.034933
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License Number State | IL
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