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General NPI Number Information
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NPI Number | 1629504808
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Entity Type | Organization
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Legal Business Name | ROBERT R. GIERING D.D.S. LTD.
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Dates
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Enumeration Date | 05/05/2017
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Last Update Date | 05/05/2017
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Provider Practice Location Address
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Address Line | 475 W 55TH ST SUITE 205
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City | COUNTRYSIDE
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State | IL
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Zip | 60525-3564
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Country | US
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Telephone | 708-354-3409
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Fax |
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Provider Business Mailing Address
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Address Line | 475 W 55TH ST SUITE 205
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City | COUNTRYSIDE
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State | IL
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Zip | 60525-3564
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Country | US
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Telephone | 708-354-3409
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ROBERT R GIERING
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Credential | D.D.S.
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Telephone | 708-354-3409
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 019016807
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License Number State | IL
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