Provider Demographics
NPI:1912995358
Name:RENIERIS, IRENE
Entity type:Individual
Prefix:
First Name:IRENE
Middle Name:
Last Name:RENIERIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1945 W. WILSON AVE SUITE #5117
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640
Mailing Address - Country:US
Mailing Address - Phone:773-588-7840
Mailing Address - Fax:773-588-0711
Practice Address - Street 1:1945 W. WILSON SUITE #5117
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640
Practice Address - Country:US
Practice Address - Phone:773-588-7840
Practice Address - Fax:773-588-0711
Is Sole Proprietor?:No
Enumeration Date:2005-10-10
Last Update Date:2023-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019-0267351223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice