Provider Demographics
NPI:1639159221
Name:SUASTEGUI, ISABEL CRISTINA (DDS)
Entity type:Individual
Prefix:DR
First Name:ISABEL
Middle Name:CRISTINA
Last Name:SUASTEGUI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1835 BROADWAY ST
Mailing Address - Street 2:
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 2:210
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:
Is Sole Proprietor?:No
Enumeration Date:2006-01-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190220831223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice