Provider Demographics
NPI:1821725839
Name:BERTUCCI, DOMINIQUE ERICA (DMD)
Entity type:Individual
Prefix:DR
First Name:DOMINIQUE
Middle Name:ERICA
Last Name:BERTUCCI
Suffix:
Gender:
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3349 S PARNELL AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60616-3517
Mailing Address - Country:US
Mailing Address - Phone:312-607-1029
Mailing Address - Fax:
Practice Address - Street 1:737 N MICHIGAN AVE STE 1330
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-5401
Practice Address - Country:US
Practice Address - Phone:312-266-8198
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-01
Last Update Date:2025-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.0349331223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry