Provider Demographics
NPI:1831480458
Name:DR ISABEL C. SUASTEGUI-MURSULI DDS LTD
Entity Type:Organization
Organization Name:DR ISABEL C. SUASTEGUI-MURSULI DDS LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ISABEL
Authorized Official - Middle Name:CRISTINA
Authorized Official - Last Name:SUASTEGUI-MURSULI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:708-345-1168
Mailing Address - Street 1:1835 BROADWAY ST
Mailing Address - Street 2:SUITE 210
Mailing Address - City:MELROSE PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60160-2040
Mailing Address - Country:US
Mailing Address - Phone:708-345-1168
Mailing Address - Fax:
Practice Address - Street 1:1835 BROADWAY ST
Practice Address - Street 2:SUITE 210
Practice Address - City:MELROSE PARK
Practice Address - State:IL
Practice Address - Zip Code:60160-2040
Practice Address - Country:US
Practice Address - Phone:708-345-1168
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-30
Last Update Date:2011-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019022083122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty