Provider Demographics
NPI:1235709213
Name:URIBE CARDENAS, CARMEN I (DMD)
Entity type:Individual
Prefix:
First Name:CARMEN
Middle Name:I
Last Name:URIBE CARDENAS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:302 E SAINT CHARLES RD STE A
Mailing Address - Street 2:
Mailing Address - City:VILLA PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60181-2473
Mailing Address - Country:US
Mailing Address - Phone:630-339-3438
Mailing Address - Fax:630-686-8414
Practice Address - Street 1:302 E SAINT CHARLES RD STE A
Practice Address - Street 2:
Practice Address - City:VILLA PARK
Practice Address - State:IL
Practice Address - Zip Code:60181-2473
Practice Address - Country:US
Practice Address - Phone:630-339-3438
Practice Address - Fax:630-686-8414
Is Sole Proprietor?:No
Enumeration Date:2021-06-30
Last Update Date:2025-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.033290122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist