Provider Demographics
NPI:1083442792
Name:RIZENTAL DELGADO, RENATA ZORAIDA (DDS)
Entity type:Individual
Prefix:
First Name:RENATA
Middle Name:ZORAIDA
Last Name:RIZENTAL DELGADO
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 1:901 S ASHLAND AVE APT 817
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60607-4089
Mailing Address - Country:US
Mailing Address - Phone:773-934-8174
Mailing Address - Fax:
Practice Address - Street 1:801 S PAULINA ST RM 127
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-7210
Practice Address - Country:US
Practice Address - Phone:312-355-1641
Practice Address - Fax:312-413-0103
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-24
Last Update Date:2024-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1360002731223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry