Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 19014696 | IL |
NPI | 1003923186 |
---|---|
Provider Name | Dr. A J Trotta |
First Address | Chicago, IL 60630-2729 |
Second Address | Chicago, IL 60630-2729 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/08/2006 |
Last Update Date | 08/07/2007 |