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General NPI Number Information
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NPI Number | 1588919989
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Entity Type | Organization
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Legal Business Name | GURNEE DENTAL ARTS
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Dates
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Enumeration Date | 07/22/2012
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Last Update Date | 07/22/2012
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Provider Practice Location Address
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Address Line | 731 S IL ROUTE 21 SUITE #160
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City | GURNEE
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State | IL
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Zip | 60031-3813
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Country | US
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Telephone | 224-433-6009
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Fax | 224-433-6397
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Provider Business Mailing Address
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Address Line | 731 S IL ROUTE 21 SUITE #160
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City | GURNEE
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State | IL
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Zip | 60031-3813
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Country | US
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Telephone | 224-433-6009
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Fax | 224-433-6397
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Authorized Official
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Title or Position | OWNER
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Name | DR. DESIREE LORENO
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Credential | DDS
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Telephone | 773-550-5919
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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 | 019-026161
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License Number State | IL
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