Provider Demographics
NPI:1528477452
Name:DIFRANCO, PAUL EDWARD (DDS, MS)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:EDWARD
Last Name:DIFRANCO
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1129 HARLEM AVE
Mailing Address - Street 2:
Mailing Address - City:FOREST PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60130-2381
Mailing Address - Country:US
Mailing Address - Phone:708-366-7846
Mailing Address - Fax:
Practice Address - Street 1:1129 HARLEM AVE
Practice Address - Street 2:
Practice Address - City:FOREST PARK
Practice Address - State:IL
Practice Address - Zip Code:60130-2381
Practice Address - Country:US
Practice Address - Phone:708-366-7846
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-05
Last Update Date:2014-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.0279011223X0400X
IL021.0025771223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics