MEDICARE: A TOPACIO DENTAL INC

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	122300000X	Dentist

General Provider Information

NPI Number	:	1174073845
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	A TOPACIO DENTAL INC

Provider Business Mailing Address
First Line	:	6508 W ARCHER AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60638-2423
Country	:	US
Telephone Number	:	219-455-1818
Fax Number	:

Provider Business Practice Location Address
First Line	:	6508 W ARCHER AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60638-2423
Country	:	US
Telephone Number	:	219-455-1818
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ALBERTO M TOPACIO
Credential	:
Telephone Number	:	219-455-1818

Provider Enumeration Date	:	10/06/2016
Last Update Date	:	10/06/2016

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