Provider Demographics
NPI:1386473288
Name:LAGARES SOUZA SANTOS, GUILHERME (DDS)
Entity type:Individual
Prefix:DR
First Name:GUILHERME
Middle Name:
Last Name:LAGARES SOUZA SANTOS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9725 WOODS DR UNIT 1015
Mailing Address - Street 2:
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60077-4453
Mailing Address - Country:US
Mailing Address - Phone:917-279-5065
Mailing Address - Fax:
Practice Address - Street 1:201 E STRONG ST STE 4
Practice Address - Street 2:
Practice Address - City:WHEELING
Practice Address - State:IL
Practice Address - Zip Code:60090-2979
Practice Address - Country:US
Practice Address - Phone:847-947-2651
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-29
Last Update Date:2024-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019035400122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist