Provider Demographics
NPI:1558528869
Name:CRISTINA THELEMAQUE DDS PC
Entity Type:Organization
Organization Name:CRISTINA THELEMAQUE DDS PC
Other - Org Name:NORTH OAK DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:GARNET
Authorized Official - Middle Name:
Authorized Official - Last Name:VENABLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-383-9363
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-22
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019022683261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental