Provider Demographics
NPI:1124287362
Name:DIMARIO DENTAL SERVICES
Entity type:Organization
Organization Name:DIMARIO DENTAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:DR
Authorized Official - First Name:VERONICA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:DIMARIO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:773-271-6168
Mailing Address - Street 1:PO BOX 256779
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60625-6779
Mailing Address - Country:US
Mailing Address - Phone:773-271-6168
Mailing Address - Fax:773-334-4537
Practice Address - Street 1:2334 W LAWRENCE AVE
Practice Address - Street 2:#208
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60625-1948
Practice Address - Country:US
Practice Address - Phone:773-271-6168
Practice Address - Fax:773-334-4537
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-03
Last Update Date:2011-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190245821223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty