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NPI Code Detail

MEDICARE: JUAN G MESA DDS

MEDICARE: JUAN G MESA DDS
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
1122300000XDentistIN

General Provider Information

NPI Number : 1386813897
Entity Type Code : Individual
Provider Name (Legal Business Name) : JUAN G MESA DDS
Provider Business Mailing 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
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 : 02/28/2008
Last Update Date : 02/28/2008

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Directions to “ JUAN G MESA DDS” Practice Location

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