MEDICARE: JAIME R MARQUEZ D.D.S. P.A.

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	019030099	IL

General Provider Information

NPI Number	:	1245624139
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JAIME R MARQUEZ D.D.S. P.A.

Provider Business Mailing Address
First Line	:	5227 W BELMONT AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60641-4210
Country	:	US
Telephone Number	:	773-677-3797
Fax Number	:

Provider Business Practice Location Address
First Line	:	5227 W BELMONT AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60641-4210
Country	:	US
Telephone Number	:	773-677-3797
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENTE
Name	:	DR. JAIME RICK MARQUEZ
Credential	:	D.D.S.
Telephone Number	:	773-677-3797

Provider Enumeration Date	:	03/27/2015
Last Update Date	:	03/27/2015

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