Provider Demographics
NPI:1669747325
Name:ONESTO, MARIE LOUISE (DDS)
Entity type:Individual
Prefix:DR
First Name:MARIE
Middle Name:LOUISE
Last Name:ONESTO
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 1:318 N BLOOMINGTON ST
Mailing Address - Street 2:
Mailing Address - City:STREATOR
Mailing Address - State:IL
Mailing Address - Zip Code:61364-2218
Mailing Address - Country:US
Mailing Address - Phone:815-672-2647
Mailing Address - Fax:815-672-5201
Practice Address - Street 1:318 N BLOOMINGTON ST
Practice Address - Street 2:
Practice Address - City:STREATOR
Practice Address - State:IL
Practice Address - Zip Code:61364-2218
Practice Address - Country:US
Practice Address - Phone:815-672-2647
Practice Address - Fax:815-672-5201
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-14
Last Update Date:2012-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019021483122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist