Provider Demographics
NPI:1306158043
Name:ZUNIGA, ADRIANA MARISOL (DDS)
Entity type:Individual
Prefix:DR
First Name:ADRIANA
Middle Name:MARISOL
Last Name:ZUNIGA
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 1:2089 W WABANSIA AVE APT 202
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60647-5603
Mailing Address - Country:US
Mailing Address - Phone:773-655-7373
Mailing Address - Fax:
Practice Address - Street 1:2160 S. FIRST AVENUE
Practice Address - Street 2:LOYOLA UNIVERSITY MEDICAL CENTER 2160 S. FIRST AVENUE
Practice Address - City:MAYWOOD
Practice Address - State:IL
Practice Address - Zip Code:60153
Practice Address - Country:US
Practice Address - Phone:888-584-1888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-10
Last Update Date:2010-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0180017701223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice