Provider Demographics
NPI:1285806265
Name:BUIS, DARLENE JO (DDS)
Entity type:Individual
Prefix:DR
First Name:DARLENE
Middle Name:JO
Last Name:BUIS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:430 W ERIE ST
Mailing Address - Street 2:STE 200
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60610-6914
Mailing Address - Country:US
Mailing Address - Phone:312-274-9957
Mailing Address - Fax:
Practice Address - Street 1:12200 WESTERN AVE
Practice Address - Street 2:#108
Practice Address - City:BLUE ISLAND
Practice Address - State:IL
Practice Address - Zip Code:60406-1398
Practice Address - Country:US
Practice Address - Phone:708-385-3700
Practice Address - Fax:708-385-3707
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-30
Last Update Date:2008-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice