| Organization Name: | ROBERT T MISERENDINO DDS LTD |
| NPI Number: | 1457583536 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | ROBERT MISERENDINO (PRESIDENT) |
| Mailing Address: | 8535 W 79th St Justice |
| State: | IL US |
| Postal Code: | 604582281 |
| Phone Number: | 7084587552 |
| Fax Number: | |
| NPI Enumeration Date: | 08/21/2009 |
| NPI Last Update Date: | 08/21/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QD0000X |
| License Number: | 019015140 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IL |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Dental |
| Taxonomy Definition: | |