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NPI Code Detail

MEDICARE: MARIA L GRACIAS DDS

MEDICARE:   MARIA L GRACIAS  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
11223G0001XGeneral Practice Dentistry019022121IL

General Provider Information

NPI Number : 1770647117
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARIA L GRACIAS DDS
Provider Business Mailing Address
First Line : 111 N WABASH AVE STE 1820
Second Line :
City : CHICAGO
State : IL
Zip : 60602-2973
Country : US
Telephone Number : 312-236-3633
Fax Number :
Provider Business Practice Location Address
First Line : 111 N WABASH AVE STE 1820
Second Line :
City : CHICAGO
State : IL
Zip : 60602-2973
Country : US
Telephone Number : 312-236-3633
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/20/2006
Last Update Date : 11/11/2010

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Directions to “ MARIA L GRACIAS DDS” Practice Location

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