Provider Demographics
NPI:1558385153
Name:THELEMAQUE, CRISTINA (DDS)
Entity Type:Individual
Prefix:DR
First Name:CRISTINA
Middle Name:
Last Name:THELEMAQUE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6711 NORTH AVE
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60302-1006
Mailing Address - Country:US
Mailing Address - Phone:708-383-9363
Mailing Address - Fax:708-383-4154
Practice Address - Street 1:6711 NORTH AVE
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60302-1006
Practice Address - Country:US
Practice Address - Phone:708-383-9363
Practice Address - Fax:708-383-4154
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice