Provider Demographics
NPI:1104385541
Name:DULANTO, ANDREINA (DDS, MS)
Entity type:Individual
Prefix:
First Name:ANDREINA
Middle Name:
Last Name:DULANTO
Suffix:
Gender:F
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3140 N CLYBOURN AVE APT 204
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60618-6876
Mailing Address - Country:US
Mailing Address - Phone:786-853-9357
Mailing Address - Fax:
Practice Address - Street 1:3140 N CLYBOURN AVE APT 204
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60618-6876
Practice Address - Country:US
Practice Address - Phone:786-853-9357
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-15
Last Update Date:2025-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0210031971223P0700X
IL0190337401223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No1223P0700XDental ProvidersDentistProsthodontics