Provider Demographics
NPI:1689777229
Name:JOHN P FIORENZA DDS PC
Entity Type:Organization
Organization Name:JOHN P FIORENZA DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:PETER
Authorized Official - Last Name:FIORENZA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:708-636-0565
Mailing Address - Street 1:5425 WEST 95TH STREET
Mailing Address - Street 2:
Mailing Address - City:OAK LAWN
Mailing Address - State:IL
Mailing Address - Zip Code:60453
Mailing Address - Country:US
Mailing Address - Phone:708-636-0565
Mailing Address - Fax:708-636-0566
Practice Address - Street 1:5425 WEST 95TH STREET
Practice Address - Street 2:
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453
Practice Address - Country:US
Practice Address - Phone:708-636-0565
Practice Address - Fax:708-636-0566
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-07
Last Update Date:2013-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019015935122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty