Provider Demographics
NPI:1891932505
Name:RENDON, VICTOR HUGO JR
Entity Type:Individual
Prefix:DR
First Name:VICTOR
Middle Name:HUGO
Last Name:RENDON
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1805 BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:MELROSE PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60160-2025
Mailing Address - Country:US
Mailing Address - Phone:708-395-5172
Mailing Address - Fax:
Practice Address - Street 1:1805 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:MELROSE PARK
Practice Address - State:IL
Practice Address - Zip Code:60160-2025
Practice Address - Country:US
Practice Address - Phone:708-395-5172
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-16
Last Update Date:2013-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.027752122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist