Provider Demographics
NPI:1437309945
Name:DENTISTAS HISPANOS FOUNDATION FOR ORAL HEALTH CARE , P.C.
Entity Type:Organization
Organization Name:DENTISTAS HISPANOS FOUNDATION FOR ORAL HEALTH CARE , P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:GIANCARLO
Authorized Official - Middle Name:
Authorized Official - Last Name:MALDONADO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:630-965-6326
Mailing Address - Street 1:1520 CRAB TREE DR
Mailing Address - Street 2:
Mailing Address - City:WESTMONT
Mailing Address - State:IL
Mailing Address - Zip Code:60559-3466
Mailing Address - Country:US
Mailing Address - Phone:630-965-6326
Mailing Address - Fax:
Practice Address - Street 1:3622 W 26TH ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60623-3936
Practice Address - Country:US
Practice Address - Phone:773-522-5252
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-22
Last Update Date:2008-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.026594261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental