MEDICARE: DR. ROBERT THOMAS MISERENDINO D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	019015140	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1134118110
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT THOMAS MISERENDINO D.D.S.

Provider Business Mailing Address
First Line	:	8535 W 79TH ST
Second Line	:
City	:	JUSTICE
State	:	IL
Zip	:	60458-2281
Country	:	US
Telephone Number	:	708-458-7552
Fax Number	:

Provider Business Practice Location Address
First Line	:	8535 W 79TH ST
Second Line	:
City	:	JUSTICE
State	:	IL
Zip	:	60458-2281
Country	:	US
Telephone Number	:	708-458-7552
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/21/2005
Last Update Date	:	08/21/2009

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