Healthcare Provider Details

I. General information

NPI: 1942662226
Provider Name (Legal Business Name): CHRISTINE THERESA CIULLO D.M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2016
Last Update Date: 11/27/2023
Certification Date: 11/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2706 N LINCOLN AVE
CHICAGO IL
60614-1321
US

IV. Provider business mailing address

2706 N LINCOLN AVE
CHICAGO IL
60614-1321
US

V. Phone/Fax

Practice location:
  • Phone: 773-250-7300
  • Fax: 773-250-7300
Mailing address:
  • Phone: 773-250-7300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number019.031378
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: