Provider Demographics
NPI:1407193071
Name:MARQUEZ CORREA, IGNACIO CHRISTIAN (DDS)
Entity Type:Individual
Prefix:MR
First Name:IGNACIO
Middle Name:CHRISTIAN
Last Name:MARQUEZ CORREA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:555 31ST STREET
Mailing Address - Street 2:
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60515
Mailing Address - Country:US
Mailing Address - Phone:630-515-7275
Mailing Address - Fax:630-515-7290
Practice Address - Street 1:555 31ST STREET
Practice Address - Street 2:
Practice Address - City:DOWNERS GROVE
Practice Address - State:IL
Practice Address - Zip Code:60515
Practice Address - Country:US
Practice Address - Phone:630-515-7275
Practice Address - Fax:630-515-7290
Is Sole Proprietor?:No
Enumeration Date:2013-01-15
Last Update Date:2013-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL136.000181122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist