Provider Demographics
NPI:1568636686
Name:MARIO F. RINCON, DDS, PC
Entity Type:Organization
Organization Name:MARIO F. RINCON, DDS, PC
Other - Org Name:AURORA LINCOLN DENTAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIO
Authorized Official - Middle Name:F
Authorized Official - Last Name:RINCON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:630-892-7967
Mailing Address - Street 1:157 S LINCOLN AVE
Mailing Address - Street 2:STE B
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60505-4264
Mailing Address - Country:US
Mailing Address - Phone:630-844-0550
Mailing Address - Fax:630-892-7967
Practice Address - Street 1:157 S LINCOLN AVE
Practice Address - Street 2:STE B
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60505-4264
Practice Address - Country:US
Practice Address - Phone:630-844-0550
Practice Address - Fax:630-892-7967
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-18
Last Update Date:2008-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty