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General NPI Number Information
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NPI Number | 1083073738
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Entity Type | Organization
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Legal Business Name | TAMMY GIANNETTA DDS
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Dates
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Enumeration Date | 02/22/2016
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Last Update Date | 02/22/2016
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Provider Practice Location Address
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Address Line | 16121 S FARRELL RD
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City | LOCKPORT
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State | IL
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Zip | 60441-8200
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Country | US
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Telephone | 815-524-5053
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Fax | 815-552-2064
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Provider Business Mailing Address
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Address Line | 16121 S FARRELL RD
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City | LOCKPORT
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State | IL
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Zip | 60441-8200
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Country | US
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Telephone | 815-524-5053
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Fax | 815-552-2064
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Authorized Official
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Title or Position | DENTIST/OWNER
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Name | DR. TAMMY GIANNETTA
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Credential | DDS
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Telephone | 815-524-5053
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 019-026431
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License Number State | IL
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