Provider Demographics
NPI:1366572802
Name:GADIA, CHRISTINE M (DDSMS)
Entity type:Individual
Prefix:DR
First Name:CHRISTINE
Middle Name:M
Last Name:GADIA
Suffix:
Gender:F
Credentials:DDSMS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:223 W JACKSON BLVD
Mailing Address - Street 2:#1275
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60606-6908
Mailing Address - Country:US
Mailing Address - Phone:312-588-0112
Mailing Address - Fax:312-588-0480
Practice Address - Street 1:223 W. JACKSON BLVD
Practice Address - Street 2:#1275
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60606-6908
Practice Address - Country:US
Practice Address - Phone:312-588-0112
Practice Address - Fax:312-588-0480
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2009-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0210021621223P0300X
IL019.0259001223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics