MEDICARE: CHRISTINE THERESA CIULLO D.M.D

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	1223G0001X	General Practice Dentistry	019.031378	IL

General Provider Information

NPI Number	:	1942662226
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTINE THERESA CIULLO D.M.D

Provider Business Mailing Address
First Line	:	2706 N LINCOLN AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60614-1321
Country	:	US
Telephone Number	:	773-250-7300
Fax Number	:

Provider Business Practice Location Address
First Line	:	2706 N LINCOLN AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60614-1321
Country	:	US
Telephone Number	:	773-250-7300
Fax Number	:	773-250-7300

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

Provider Enumeration Date	:	03/24/2016
Last Update Date	:	11/27/2023

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