Provider Demographics
NPI:1841563467
Name:ALZONA-CORREA, MARJORIE
Entity Type:Individual
Prefix:DR
First Name:MARJORIE
Middle Name:
Last Name:ALZONA-CORREA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5901 DEMPSTER ST
Mailing Address - Street 2:SUITE 105
Mailing Address - City:MORTON GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60053-3014
Mailing Address - Country:US
Mailing Address - Phone:847-372-5227
Mailing Address - Fax:
Practice Address - Street 1:5901 DEMPSTER ST
Practice Address - Street 2:SUITE 105
Practice Address - City:MORTON GROVE
Practice Address - State:IL
Practice Address - Zip Code:60053-3014
Practice Address - Country:US
Practice Address - Phone:847-372-5227
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-13
Last Update Date:2012-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190230421223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice