Provider Demographics
NPI:1285884908
Name:MARRERO, ROBERT A JR (DDS)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:A
Last Name:MARRERO
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2009 W NORTH AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60647-5496
Mailing Address - Country:US
Mailing Address - Phone:773-227-2110
Mailing Address - Fax:773-227-2670
Practice Address - Street 1:2009 W NORTH AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60647-5496
Practice Address - Country:US
Practice Address - Phone:773-227-2110
Practice Address - Fax:773-227-2670
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-30
Last Update Date:2008-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019 0218511223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice