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General NPI Number Information
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NPI Number | 1922450527
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Entity Type | Individual
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Provider Name | BRYAN STRIFFOLINO
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Gender | Male
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Dates
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Enumeration Date | 07/07/2016
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Last Update Date | 07/07/2016
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Provider Practice Location Address
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Address Line | 2410 SAMPSON ST BUILDING 237
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City | GREAT LAKES
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State | IL
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Zip | 60088-2942
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Country | US
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Telephone | 847-688-3331
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Fax |
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Provider Business Mailing Address
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Address Line | 2027 W SKYHAWK AVE APT 301
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City | WAUKEGAN
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State | IL
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Zip | 60087-5728
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Country | US
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Telephone | 443-850-9293
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 15970
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License Number State | MD
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