NPI 1063849776

Suzy Azalea

Practitioner Dentist Bolingbrook, IL

Practice location

Address: 761 E Boughton Rd, Bolingbrook, IL 60440-2281
Phone: (630) 739-9430

Registered specialties

Dentist Primary

Dental Providers Taxonomy 122300000X Licence 019024791 (IL)

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Registry record

NPI: 1063849776
Entity type: Individual
Sex (as registered): Female
NPI issued: 26 Sep 2013
Record last updated: 26 Sep 2013

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.