MEDICARE: DR. MURILLO DDS 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	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1548803935
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR. MURILLO DDS INC

Provider Business Mailing Address
First Line	:	5036 S ARCHER AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60632-4247
Country	:	US
Telephone Number	:	773-424-5759
Fax Number	:	773-424-6021

Provider Business Practice Location Address
First Line	:	5036 S ARCHER AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60632-4247
Country	:	US
Telephone Number	:	773-424-5759
Fax Number	:	773-424-6021

Authorized Official
Title or Position	:	DENTIST
Name	:	BLANCA ESTELA MURILLO
Credential	:
Telephone Number	:	773-424-5759

Provider Enumeration Date	:	10/18/2019
Last Update Date	:	10/18/2019

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