Healthcare Provider Details

I. General information

NPI: 1104385541
Provider Name (Legal Business Name): ANDREINA DULANTO DDS, MS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/15/2019
Last Update Date: 09/29/2026
Certification Date: 07/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3140 N CLYBOURN AVE APT 204
CHICAGO IL
60618-6876
US

IV. Provider business mailing address

3140 N CLYBOURN AVE APT 204
CHICAGO IL
60618-6876
US

V. Phone/Fax

Practice location:
  • Phone: 786-853-9357
  • Fax:
Mailing address:
  • Phone: 786-853-9357
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number019033740
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number021003197
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: