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General NPI Number Information
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NPI Number | 1922146778
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Entity Type | Organization
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Legal Business Name | GERALD L WINE DDS AND DANIEL L LASSMAN DDS LTD
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Dates
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Enumeration Date | 02/02/2007
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Last Update Date | 07/16/2015
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Provider Practice Location Address
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Address Line | 2632 W DIVISION ST
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City | CHICAGO
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State | IL
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Zip | 60622-2950
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Country | US
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Telephone | 773-235-0980
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Fax | 773-235-1249
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Provider Business Mailing Address
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Address Line | 2632 W DIVISION ST
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City | CHICAGO
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State | IL
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Zip | 60622-2950
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Country | US
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Telephone | 773-235-0980
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Fax | 773-235-1249
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | NIDZA ALICEA
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Credential |
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Telephone | 773-235-0990
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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 |
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License Number State |
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