Provider Demographics
NPI:1588919989
Name:GURNEE DENTAL ARTS
Entity type:Organization
Organization Name:GURNEE DENTAL ARTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DESIREE
Authorized Official - Middle Name:
Authorized Official - Last Name:LORENO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:773-550-5919
Mailing Address - Street 1:731 S IL ROUTE 21
Mailing Address - Street 2:SUITE #160
Mailing Address - City:GURNEE
Mailing Address - State:IL
Mailing Address - Zip Code:60031-3813
Mailing Address - Country:US
Mailing Address - Phone:224-433-6009
Mailing Address - Fax:224-433-6397
Practice Address - Street 1:731 S IL ROUTE 21
Practice Address - Street 2:SUITE #160
Practice Address - City:GURNEE
Practice Address - State:IL
Practice Address - Zip Code:60031-3813
Practice Address - Country:US
Practice Address - Phone:224-433-6009
Practice Address - Fax:224-433-6397
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-22
Last Update Date:2012-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019-026161261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental