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NPI Code Detail

MEDICARE: DR. JAIRO H PATINO D.D.S.

MEDICARE: DR. JAIRO H PATINO 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
1122300000XDentistIL

General Provider Information

NPI Number : 1174721088
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JAIRO H PATINO D.D.S.
Provider Business Mailing Address
First Line : 1130 S MICHIGAN AVE
Second Line : APT 1809
City : CHICAGO
State : IL
Zip : 60605-2521
Country : US
Telephone Number : 312-405-1040
Fax Number :
Provider Business Practice Location Address
First Line : 3190 N ELSTON AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60618-5845
Country : US
Telephone Number : 773-267-9777
Fax Number : 773-267-9662
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/03/2007
Last Update Date : 07/08/2007

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