MEDICARE: ANDREINA DULANTO DDS, MS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223P0700X	Prosthodontics	021003197	IL
2	1223G0001X	General Practice Dentistry	019033740	IL

General Provider Information

NPI Number	:	1104385541
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREINA DULANTO DDS, MS

Provider Business Mailing Address
First Line	:	3140 N CLYBOURN AVE APT 204
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60618-6876
Country	:	US
Telephone Number	:	786-853-9357
Fax Number	:

Provider Business Practice Location Address
First Line	:	3140 N CLYBOURN AVE APT 204
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60618-6876
Country	:	US
Telephone Number	:	786-853-9357
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/15/2019
Last Update Date	:	07/01/2025

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